Acute Toxicity and Triphasic Waves-The Example of Cefepime.

Area of Science:

• Neurology
• Clinical Neurophysiology
• Pharmacology

Background:

• Triphasic waves (TWs) are EEG patterns linked to various toxic encephalopathies.
• Cefepime is an antibiotic increasingly recognized as a cause of drug-induced encephalopathy.

Purpose of the Study:

• To evaluate cefepime-induced encephalopathy.
• To characterize the clinical, electroencephalographic (EEG), and radiologic findings associated with cefepime-induced encephalopathy, specifically focusing on TWs.

Main Methods:

• A retrospective, multicenter, observational study was conducted.
• Included adult patients with cefepime-induced encephalopathy and generalized periodic discharges with triphasic morphology on EEG between January 2014 and January 2020.
• Excluded patients where cefepime was not the sole cause of encephalopathy.

Main Results:

• Twenty-seven patients with cefepime-induced encephalopathy and TWs were identified.
• The median age was 63 years; 67% had renal impairment, and 81% had pre-existing white matter disease.
• TWs were often state-dependent or stimulus-sensitive; all patients improved after cefepime discontinuation.

Conclusions:

• Cefepime toxicity should be considered in encephalopathic patients exhibiting TWs.
• Pre-existing white matter disease increases suspicion, especially in younger patients or those without renal dysfunction.
• EEG monitoring is crucial for diagnosing and managing cefepime-induced encephalopathy.