Nonconvulsive Status Epilepticus Caused by Cephalosporins in Patients with Renal Failure

ABSTRACT

PURPOSE: To describe the clinical features of nonconvulsive status epilepticus (NCSE) associated with cephalosporins in patients with renal failure and to emphasize the importance of EEG in diagnosing NCSE in patients with altered consciousness.METHODS: We described the detailed clinical characteristics of 8 patients with renal failure who underwent cephalosporin-induced NCSE.RESULTS: Six of the patients showed unresponsiveness with preserved alertness and two patients presented confusion and irritability. 6 patients presented altered consciousness with intermittent jerky movements of face or arms. Altered consciousness developed 6+/-5 days (mean+/-SD) after starting the above antibiotics. The EEG showed continuous generalized high voltage 1.0 to 2.5 Hz sharp waves or sharp and wave complexes. All patients improved 3+/-1 days after withdrawing the offending antibiotics without administration of antiepileptic drugs.CONCLUSIONS: Cephalosporin-induced NCSE should be differentiated from metabolic encephalopathy in patients with renal failure, which is clinically difficult. Early detection with EEG and withdrawal of the offending antibiotics can result in full recovery.