J Neurocrit Care.  2019 Dec;12(2):74-84. 10.18700/jnc.190109.

Cefepime-induced neurotoxicity

• Lee SJ

• KMID: 2470468
• DOI: http://doi.org/10.18700/jnc.190109

Abstract

Cefepime, a widely used fourth-generation cephalosporin, has been reported to cause neurotoxicity because it crosses the blood-brain barrier. Although cefepime-induced neurotoxicity (CIN) occurs in patients with renal dysfunction administered a high dosage, CIN has also been reported in patients with normal renal function administered the appropriate dosage. CIN is characterized by toxic encephalopathy and electroencephalography abnormalities, such as triphasic wave, currently renamed as generalized periodic discharge (GPD) with triphasic morphology, and nonconvulsive status epilepticus (NCSE). Toxic encephalopathy appears 2 to 6 days after cefepime administration and disappears 3 days after discontinuation of cefepime. Electroencephalography abnormalities in most reported cases are GPD with triphasic morphology rather than NCSE. CIN is reversible in most cases if early detection and discontinuation of cefepime is possible, which is the only definitive treatment; however, anticonvulsant therapy is unnecessary except for patients with convulsive seizures or definite NCSE. Emergent hemodialysis may also be helpful in life-threatening situations.

Keyword

Cefepime; Neurotoxicity syndromes; Generalized periodic discharges; Triphasic waves; Nonconvulsive status epilepticus

MeSH Terms

Blood-Brain Barrier
Electroencephalography
Humans
Neurotoxicity Syndromes
Renal Dialysis
Seizures
Status Epilepticus

Figure

• 

  Fig. 1. Example of triphasic wave (TW) pattern in patients with cefepime-induced neurotoxicity. Electroencephalography showing slow, typical TW (A) and fast, atypical TW (B), “TW look-alikes”; the latter is difficult to differentiate from nonconvulsive status epilepticus. (A) Modified from Baek et al. [41], according to the Creative Commons License; (B) is a personal case of the author.

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