Ceftazidime-Induced Non-Convulsive Status Epilepticus (NCSE) in a Pediatric Patient with Literature Review

Year 2024, , 85 - 93, 29.08.2024

Mehpare Sarı Yanartaş , Sait Açık , Özlem Yayıcı Köken , Gülşah Aksoy , Şenay Haspolat

https://doi.org/10.47493/abantmedj.1413064

Abstract

Cephalosporins are a class of antibiotics routinely prescribed for a variety of pediatric infections. Among uncommon adverse effects, cephalosporins can be neurotoxic and epileptogenic, particularly in patients with reduced renal function. Neurotoxic effects are most frequently observed in adults with impaired renal function, and they have rarely been recorded in children. An 11-year-old boy with chronic renal failure experienced non-convulsive status epilepticus two days after initiating intravenous cefazolin and ceftazidime with a pre-diagnosis of peritonitis. The patient's mental condition reverted to baseline within hours after intravenous antibiotic treatment was discontinued and appropriate antiepileptic and anticonvulsive therapy was started. Providers should investigate cephalosporin-induced non-convulsive status epilepticus clinically and electrophysiologically in any child with renal impairment who demonstrates acute changes in mental status or decreased awareness after initiating intravenous cephalosporins.

Keywords

ephalosporin, non-convulsive status epilepticus, renal failure

Pediatrik Hastada Seftazidime Bağlı Non-Konvülsif Status Epileptikus (NKSE) Olgusu; Literatür Derlemesi ile

Abstract

Sefalosporinler, çeşitli pediatrik enfeksiyonların tedavisinde rutin olarak reçete edilen bir antibiyotik sınıfıdır. Seyrek görülen yan etkiler arasında, sefalosporinlerin özellikle böbrek fonksiyonu azalmış hastalarda nörotoksik ve epileptojenik olabileceği belirtilmiştir. Nörotoksik etkiler, özellikle böbrek fonksiyonu bozulmuş yetişkinlerde daha sık gözlenirken, çocuklarda nadiren bildirilmiştir. Kronik böbrek yetmezliği tanısı ile takip edilen 11 yaşındaki erkek hastada peritonit ön tanısı ile intravenöz sefazolin ve seftazidim tedavisine başladıktan iki gün sonra non-konvülsif status epileptikus tablosu gelişmiştir. Hasta intravenöz antibiyotik tedavisinin kesilmesi ve uygun antikonvülsan tedavinin başlatılmasının ardından birkaç saat içinde mental durumu normale dönmüştür. İntravenöz sefalosporin başlanmasının ardından akut mental durum değişiklikleri gösteren her çocuk hastada klinik ve elektrofizyolojik olarak sefalosporin kaynaklı non-konvülsif status epileptikus akla gelmesi gereken ön tanılardan biridir.

Keywords

sefalosporin, nonkonvulzif status epileptikus, renal yetmezlik

References

• Grill MF, Maganti R. Cephalosporin-induced neurotoxicity: clinical manifestations, potential pathogenic mechanisms, and the role of electroencephalographic monitoring. Ann Pharmacother 2008; 42(12): 1843–50. http://doi.org/ 10.1345/aph.1L307
• Kim KB, Kim SM, Park W, Kim JS, Kwon SK, Kim HY. Ceftriaxone-induced neurotoxicity: case report, pharmacokinetic consideration, and literature review. J Korean Med Sci 2012; 27(9): 1120–1123. http://doi.org/10.3346/jkms.2012.27.9.1120
• Bora I, Demir, AB, Uzun, P. Nonconvulsive status epilepticus cases arising in connection with cephalosporins. Epilepsy Behav Case Rep 2016; 6: 23-27. http://doi.org/10.1016/j.ebcr.2016.04.005
• Hirsch LJ, Fong MWK, Leitinger M, LaRoche SM, Beniczky S, Abend NS et al. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version. J Clin Neurophysiol 2021; 38(1): 1-29. http://doi.org/10.1097/WNP.0000000000000806
• Primavera A, Cocito L, Audenino D. Nonconvulsive status epilepticus during cephalosporin therapy. Neuropsychobiology. 2004;49(4):218-22. doi: 10.1159/000077370.
• Vannaprasaht S, Tawalee A, Mayurasakorn N, Yodwut C, Bansong R, Reungjui S et al. Ceftazidime overdose-related nonconvulsive status epilepticus after intraperitoneal instillation. Clin Toxicol (Phila) 2006; 44(4): 383-6. http://doi.org/10.1080/15563650600671753
• Wallace KL. Antibiotic-induced convulsion. Crit Care Clin 1997; 13(4): 741–762. http://doi.org/10.1016/s0749-0704(05)70367-5
• Sugimoto M, Uchida I, Mashimo T, Yamazaki S, Hatano K, Ikeda F. Evidence for the involvement of GABA(A) receptor blockade in convulsions induced by cephalosporins. Neuropharmacology 2003; 45(3): 304–314. http://doi.org/ doi:10.1016/s0028-3908(03)00188-6
• Chen CC, Lee DJ, Lin SH. Reversible cefazolin-induced status epilepticus in a peritoneal dialysis patient. Toxicol Rep 2022; 9: 1950-1952. http://doi.org/10.1016/j.toxrep.2022.10.011
• Al-Sadawi M, Rodriguez Ortega R, Sun N, Abdurahimova M, McFarlane SI. Jerky Movement with Ceftazidime: A Case of Ceftazidime-Induced Neurotoxicity with a Review of the Literature. Case Rep Med 2019. 8936478. http://doi.org/10.1155/2019/8936478
• Ong CY, Qin Y. Myoclonus from Antibiotic Therapy (Ceftazidime-induced Neurotoxicity): A Case Report and Review. Cureus 2018; 10(3): e2250. http://doi.org/10.7759/cureus.2250
• Roncan-Albuquerque R, Pires I, Martins R, Real R, Sousa G, Von Hafe P. Ceftriaxone-induced acute reversible encephalopathy in a patient treated for a urinary tract infection. Neth J Med 2009; 67(2): 72-75.
• Nguyen C, Clegg T, Kumar A, Paudel S. Cefepime-Induced Nonconvulsive Status Epilepticus in a Pediatric Patient with Normal Renal Function. Child Neurol Open 2022; 7: 9:2329048X221119575. http://doi.org/10.1177/2329048X221119575
• Chedrawi AK, Gharaybeh SI, Al-Ghwery SA, Al-Mohaimeed SA, Alshahwan SA. Cephalosporin-induced nonconvulsive status epilepticus in a uremic child. Pediatr Neurol. 2004 Feb;30(2):135-9. doi: 10.1016/j.pediatrneurol.2003.07.006.
• Alpay H, Altun O, Biyikli NK. Cefepime-induced non-convulsive status epilepticus in a peritoneal dialysis patient. Pediatr Nephrol. 2004 Apr;19(4):445-7. doi: 10.1007/s00467-003-1333-8
• Thabet F, Al Maghrabi M, Al Barraq A, Tabarki B. Cefepime-induced nonconvulsive status epilepticus: case report and review. Neurocrit Care. 2009;10(3):347-51. doi: 10.1007/s12028-008-9166-8
• Nichols, K. R., Brown, D. M., Knoderer, C. A., & Andreoli, S. P. (2011). Cefepime Neurotoxicity in an Adolescent Cystic Fibrosis Patient with Aminoglycoside-Induced Acute Kidney Injury. Journal of Pharmacy Technology, 27(4), 164–167.doi:10.1177/875512251102700404
• Landgrave LC, Lock JL, Whitmore JM, Belcher CE. Pediatric cefepime neurotoxicity. Pediatr Neurol. 2012 Dec;47(6):458-60. doi: 10.1016/j.pediatrneurol.2012.08.017.
• Ekici A, Yakut A, Kural N, Bör Ö, Yimenicioğlu S, Çarman KB. Nonconvulsive status epilepticus due to drug induced neurotoxicity in chronically ill children. Brain Dev. 2012 Nov;34(10):824-8. doi: 10.1016/j.braindev.2012.02.004.
• Shah S, Bland S. Cefepime-Induced Encephalopathy With Seizures in a Pediatric Patient With End-Stage Renal Disease Rapidly Reversed by High-Efficiency Hemodialysis. Cureus. 2021 Mar 12;13(3):e13842. doi: 10.7759/cureus.13842.
• Hambrick HR, Pavia K, Tang Girdwood S, Lazear D, Taylor JM, Benoit S. Cefepime-Associated Neurotoxicity in a Pediatric Patient With Stage V Chronic Kidney Disease. J Pharm Pract. 2022 Sep 8:8971900221125000. doi: 10.1177/08971900221125000.