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Usefulness of bilateral bispectral index (BIS) monitoring in a comatose patient with myoclonic status epilepticus secondary to cefepime

Abstract: Background: Status epilepticus, particularly non-convulsive status epilepticus (NCSE), is a frequent complication in patients with altered renal function receiving treatment with intravenous cefepime. To the best of our knowledge, we report the first case, illustrated by video-EEG, of a critically ill patient receiving treatment with cefepime who developed an episode of confirmed symptomatic myoclonic status epilepticus (MSE). Methods: Case report and video-EEG. Results: A 60-year-old man, who had received a liver transplant due to alcoholic cirrhosis one year ago, was admitted to our intensive care unit due to septic shock. Computed tomography revealed a prostatic abscess as cause of his sepsis. On Day 27, a respiratory infection due to Pseudomona aeruginosa was diagnosed, and treatment with intravenous cefepime (2 g/8 hours) was initiated. On Day 32, his mental status deteriorated and he developed inattention, a reduced level of consciousness, and multifocal and generalised continuous myoclonic jerks. A video-EEG study was compatible with the diagnosis of symptomatic MSE. On Day 35, cefepime was stopped and general anaesthesia with midazolam was started in order to achieve a faster clinical improvement. We used the BIS-Vista? monitor to guide general anaesthesia and detect potential episodes of NCSE. On Day 40, an EEG confirmed the existence of moderate diffuse encephalopathy. Finally, the patient died as a consequence of severe heart failure. Conclusions: Cefepime may be a cause of MSE in non-anoxic comatose patients. Clinicians should be aware of this possibility when evaluating comatose patients on cephalosporin therapy in order to establish a correct diagnostic approach and accurate prognosis. [Published with video sequences]. Keywords: bilateral bispectral index; cefepime; continuous EEG monitoring; drug-induced myoclonus; myoclonic status epilepticus.

 Autoría: Fernández-Torre J., Hernandez-Hernández M., Rodri?uez-Borregán J., Gonzalez-Quintanilla V.,

 Fuente: Epileptic Disorders : International Epilepsy Journal with Videotape, 15(4), 444-450

 Editorial: Wiley

 Año de publicación: 2013

 Nº de páginas: 7

 Tipo de publicación: Artículo de Revista

 DOI: 10.1684/epd.2013.0614

 ISSN: 1294-9361,1950-6945

 Url de la publicación: https://doi.org/10.1684/epd.2013.0614