PMID- 30915188
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 1941-8744 (Print)
IS  - 1941-8752 (Electronic)
IS  - 1941-8744 (Linking)
VI  - 9
IP  - 2
DP  - 2019 Apr
TI  - Cefepime-Induced Encephalopathy and Nonconvulsive Status Epilepticus: Dispelling 
      an Artificial Dichotomy.
PG  - 100-104
LID - 10.1177/1941874418803225 [doi]
AB  - Cefepime is a fourth-generation cephalosporin antibiotic known to have neurotoxic 
      side effects. Recent reports have described patients on cefepime presenting with 
      altered mentation and concurrent triphasic wave discharges on 
      electroencephalogram (EEG). Some have described this clinical presentation as 
      cefepime-induced encephalopathy, while others have termed it as cefepime-induced 
      nonconvulsive status epilepticus (NCSE). We report on 4 patients who developed 
      cefepime-associated altered mentation with triphasic discharges on EEG. A 
      benzodiazepine trial was attempted in 3 of the patients, all of whom had 
      improvement in the frequency of the triphasic discharges, but only 2 of whom 
      demonstrated a concurrent partial and transient improvement in mental status. All 
      4 patients had normalization of mental status upon discontinuation of cefepime. 
      We provide a literature review of prior cases and propose that these reports, 
      including those labeled as NCSE, are best described as a cefepime-induced 
      encephalopathy with triphasic discharges as opposed to an ictal phenomenon. We 
      contend that aggressive treatment with anti-seizure medications is not warranted 
      and that cefepime discontinuation is the definitive treatment. This case series 
      and review of the literature clarifies a long-standing terminological ambiguity 
      in a unique clinical picture that can be encountered by the neurohospitalist or 
      other providers.
FAU - Tchapyjnikov, Dmitry
AU  - Tchapyjnikov D
AUID- ORCID: 0000-0001-5649-5880
AD  - Division of Pediatric Neurology, Duke University Medical Center, Durham, NC, USA.
FAU - Luedke, Matthew W
AU  - Luedke MW
AD  - Department of Neurology, Duke University Medical Center, Durham, NC, USA.
LA  - eng
PT  - Journal Article
DEP - 20181015
PL  - United States
TA  - Neurohospitalist
JT  - The Neurohospitalist
JID - 101558199
PMC - PMC6429673
OTO - NOTNLM
OT  - EEG
OT  - cefepime
OT  - encephalopathy
OT  - nonconvulsive status epilepticus
COIS- Declaration of Conflicting Interests: The authors declared following potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article: Dr. Dmitry Tchapyjnikov has received consultation 
      fees from Guidepoint and IQVIA.
EDAT- 2019/03/28 06:00
MHDA- 2019/03/28 06:01
PMCR- 2020/04/01
CRDT- 2019/03/28 06:00
PHST- 2019/03/28 06:00 [entrez]
PHST- 2019/03/28 06:00 [pubmed]
PHST- 2019/03/28 06:01 [medline]
PHST- 2020/04/01 00:00 [pmc-release]
AID - 10.1177_1941874418803225 [pii]
AID - 10.1177/1941874418803225 [doi]
PST - ppublish
SO  - Neurohospitalist. 2019 Apr;9(2):100-104. doi: 10.1177/1941874418803225. Epub 2018 
      Oct 15.