PMID- 33614301
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210223
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 1
DP  - 2021 Jan 13
TI  - New Onset Non-Convulsive Status Epilepticus Despite Cefepime Renal Dose 
      Adjustment.
PG  - e12689
LID - 10.7759/cureus.12689 [doi]
LID - e12689
AB  - Cefepime, a widely used fourth-generation cephalosporin for coverage of both 
      gram-positive and gram-negative bacteria, has been reported to have associated 
      neurological adverse effects. These effects have been seen mostly in patients 
      mostly with impaired renal function, and currently, dosing is based on creatinine 
      clearance to reduce its toxic effect profile. Despite renal dose adjustment, we 
      present a case of a 40-year-old woman who was managed for Escherichia coli 
      bacteremia, acute kidney injury, and hemorrhagic shock. About 96 hours after 
      cefepime therapy was commenced, she was noted to be twitching with passive 
      movement of her upper limb and myoclonus of the facial muscles. Her workup 
      including computed tomography (CT) scan of the head and magnetic resonance 
      imaging (MRI) brain were negative. Electroencephalograph (EEG) showed 2 Hertz 
      sharply contoured triphasic form rhythmic waves suggestive of nonconvulsive 
      status epilepticus (NCSE). She received antiseizure medications and later had 
      hemodialysis for effective clearance of cefepime. She had significant improvement 
      in her neurological status following hemodialysis and a repeat EEG showed no 
      further seizure activity. Clinicians should be aware of the risk of NCSE in 
      patients on cefepime despite renal dose adjustment. Once identified, immediate 
      discontinuation of the offending drug, treatment with benzodiazepines, and 
      clearance of the medication with hemodialysis is recommended.
CI  - Copyright (c) 2021, Oyenuga et al.
FAU - Oyenuga, Mosunmoluwa
AU  - Oyenuga M
AD  - Internal Medicine, SSM Health St. Mary's Hospital, St. Louis, USA.
FAU - Oyenuga, Abayomi
AU  - Oyenuga A
AD  - Internal Medicine, University of Minnesota School of Medicine, Minneapolis, USA.
FAU - Rauf, Abdul
AU  - Rauf A
AD  - Internal Medicine, SSM Health St. Mary's Hospital, St. Louis, USA.
FAU - Balogun, Omotola
AU  - Balogun O
AD  - Internal Medicine, Einstein Medical Center Philadelphia, Philadephia, USA.
FAU - Singh, Niranjan
AU  - Singh N
AD  - Neurology, SSM Health St. Mary's Hospital, St. Louis, USA.
LA  - eng
PT  - Case Reports
DEP - 20210113
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7883526
OTO - NOTNLM
OT  - cefepime
OT  - cefepime induced neurotoxicity
OT  - cefepime-induced seizures
OT  - drug-induced seizures
OT  - encephalopathy
OT  - neurotoxicity
OT  - non-convulsive status epilepticus
OT  - nsce
OT  - seizure
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/02/23 06:00
MHDA- 2021/02/23 06:01
PMCR- 2021/01/13
CRDT- 2021/02/22 05:56
PHST- 2021/02/22 05:56 [entrez]
PHST- 2021/02/23 06:00 [pubmed]
PHST- 2021/02/23 06:01 [medline]
PHST- 2021/01/13 00:00 [pmc-release]
AID - 10.7759/cureus.12689 [doi]
PST - epublish
SO  - Cureus. 2021 Jan 13;13(1):e12689. doi: 10.7759/cureus.12689.