Home
|
Inbox
|
Search
|
View Abstract
A Prolonged Course of Refractory Nonconvulsive Status Epilepticus After Cefepime Treatment: A Case Report
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A6889 - A Prolonged Course of Refractory Nonconvulsive Status Epilepticus After Cefepime Treatment: A Case Report
Author Block: P. T. Taweesedt, I. Ndebbio, M. Bachan, Z. Khan; James J. Peter VA Medical Center, Bronx, NY, United States.
Introduction
Nonconvulsive status epilepticus (NCSE) is not uncommon but is often underdiagnosed. NCSE can present in various ways from typical absence, complex partial status epilepticus or altered mental status. Electroencephalogram (EEG) is crucial for diagnosis and monitoring the treatment.
Case presentation
We report a case of a 60-year-old man with incomplete quadriplegia who presented with altered mental status. He was found to have urinary tract infection (UTI), which was treated with cefepime with clinical improvement. However, he developed acute worsening in mental status requiring intubation to protect his airway. He was diagnosed with NSCE after video EEG monitoring showed continuous epileptiform discharges without clear clinical convulsive activity. Treatment with high doses of three anti-epileptic drugs (AEDs) failed to suppress his seizure activities. Anesthetic agents were added for treatment of refractory status epilepticus and were weaned of after clinical improvement. At best he was able to follow commands, open eyes, make facial gestures and make some limb movements. The NCSE episodes recurred multiple times and patient required to be placed on more AEDs and anesthetic agents. The longest seizure free period in which he was awake and able to interact was 2 months. He returned to his baseline mentation during NCSE free periods. Unfortunately, with multiple recurrent periods of NCSE and frequent critical care admissions over a period of 18 months, he died due to complication from aspiration pneumonia with septic shock.
Discussion
NCSE is defined as persistent clinical or electrographic seizure activity without convulsive motor manifestations. It is associated with increased morbidity/mortality. In this population, very little evidence-based data exists on treatment options. Our patient had prolonged, refractory NCSE intermittently for 18 months after the initial presentation following a course of cefepime for UTI, which has been identified as a possible trigger for NCSE. NCSE is not uncommon, but prolonged refractory manifestation of NCSE found in our patient is rare. Amazingly, he was still able to communicate in between NCSE episodes that were sometimes weeks in duration!
Author Block: P. T. Taweesedt, I. Ndebbio, M. Bachan, Z. Khan; James J. Peter VA Medical Center, Bronx, NY, United States.
Introduction
Nonconvulsive status epilepticus (NCSE) is not uncommon but is often underdiagnosed. NCSE can present in various ways from typical absence, complex partial status epilepticus or altered mental status. Electroencephalogram (EEG) is crucial for diagnosis and monitoring the treatment.
Case presentation
We report a case of a 60-year-old man with incomplete quadriplegia who presented with altered mental status. He was found to have urinary tract infection (UTI), which was treated with cefepime with clinical improvement. However, he developed acute worsening in mental status requiring intubation to protect his airway. He was diagnosed with NSCE after video EEG monitoring showed continuous epileptiform discharges without clear clinical convulsive activity. Treatment with high doses of three anti-epileptic drugs (AEDs) failed to suppress his seizure activities. Anesthetic agents were added for treatment of refractory status epilepticus and were weaned of after clinical improvement. At best he was able to follow commands, open eyes, make facial gestures and make some limb movements. The NCSE episodes recurred multiple times and patient required to be placed on more AEDs and anesthetic agents. The longest seizure free period in which he was awake and able to interact was 2 months. He returned to his baseline mentation during NCSE free periods. Unfortunately, with multiple recurrent periods of NCSE and frequent critical care admissions over a period of 18 months, he died due to complication from aspiration pneumonia with septic shock.
Discussion
NCSE is defined as persistent clinical or electrographic seizure activity without convulsive motor manifestations. It is associated with increased morbidity/mortality. In this population, very little evidence-based data exists on treatment options. Our patient had prolonged, refractory NCSE intermittently for 18 months after the initial presentation following a course of cefepime for UTI, which has been identified as a possible trigger for NCSE. NCSE is not uncommon, but prolonged refractory manifestation of NCSE found in our patient is rare. Amazingly, he was still able to communicate in between NCSE episodes that were sometimes weeks in duration!
|
Home
|
Inbox
|
Search
|