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Cefepime-Induced Encephalopathy and Nonconvulsive Status Epilepticus: Dispelling an Artificial Dichotomy

Dmitry Tchapyjnikov1, Matthew W Luedke2

  • 1Division of Pediatric Neurology, Duke University Medical Center, Durham, NC, USA.

The Neurohospitalist
|March 28, 2019
PubMed

Insights

Cefepime antibiotic can cause altered mental status and EEG changes. Discontinuing cefepime is the definitive treatment for this cefepime-induced encephalopathy, not anti-seizure medications.

Area of Science:

  • Neuroscience
  • Pharmacology
  • Neurology

Background:

  • Cefepime, a fourth-generation cephalosporin, is associated with neurotoxic side effects.
  • Patients on cefepime may exhibit altered mentation and electroencephalogram (EEG) triphasic wave discharges.
  • This presentation has been variably termed cefepime-induced encephalopathy or nonconvulsive status epilepticus (NCSE).

Purpose of the Study:

  • To report on patients with cefepime-associated altered mentation and EEG triphasic discharges.
  • To review the literature and clarify the terminology surrounding this clinical presentation.
  • To propose that cefepime-induced encephalopathy is a more accurate description than NCSE.

Main Methods:

  • Case series of 4 patients with cefepime-associated altered mentation and EEG triphasic discharges.
  • Administration of benzodiazepine trials in 3 patients.
  • Literature review of prior reported cases.

Main Results:

  • All 4 patients showed normalization of mental status upon cefepime discontinuation.
  • Benzodiazepine trials reduced EEG triphasic discharge frequency in 3 patients, with partial, transient mental status improvement in 2.
  • The study suggests cefepime-induced encephalopathy with triphasic discharges, not an ictal phenomenon.

Conclusions:

  • The clinical picture is best described as cefepime-induced encephalopathy with triphasic discharges.
  • Aggressive treatment with anti-seizure medications is not warranted.
  • Cefepime discontinuation is the definitive treatment for this adverse effect.
Keywords:
EEGcefepimeencephalopathynonconvulsive status epilepticus

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