Drug Induced NCSE

 Q: Which antibiotic is most notorious to cause Non-Convulsive Status Epilepticus (NCSE)? 

Answer: Cefepime 

 Drug-induced NCSE is frequently missed in ICU. Beta-lactam antibiotics are well known to cause NCSE particularly in the presence of kidney dysfunction. The most notorious antibiotic known in this regard is cefepime. Other drugs to cause NSCE are quinolones, ifosfamide, L-asparaginase, cisplatin, and busulfan. Immunosuppressant drugs such as cyclosporine and tacrolimus cause NSCE indirectly by causing posterior reversible encephalopathy syndrome (PRES).

#neurology

#pharmacology

References:

1. Fugate JE, Kalimullah EA, Hocker SE, et al. Cefepime neurotoxicity in the intensive care unit: a cause of severe, underappreciated encephalopathy. Crit Care 2013; 17:R264. 

2. Anzellotti F, Ricciardi L, Monaco D, et al. Cefixime-induced nonconvulsive status epilepticus. Neurol Sci 2012; 33:325. 

3. Thabet F, Al Maghrabi M, Al Barraq A, Tabarki B. Cefepime-induced nonconvulsive status epilepticus: case report and review. Neurocrit Care 2009; 10:347. 

4. Naeije G, Lorent S, Vincent JL, Legros B. Continuous epileptiform discharges in patients treated with cefepime or meropenem. Arch Neurol 2011; 68:1303. 

5.  Kozak OS, Wijdicks EF, Manno EM, et al. Status epilepticus as initial manifestation of posterior reversible encephalopathy syndrome. Neurology 2007; 69:894.