title: 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].
authors.affiliation: Department of Clinical Neurophysiology, Marqués de Valdecilla University Hospital, Department of Physiology and Pharmacology, University of Cantabria (UNICAN), Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV).
authors.forename: José L
authors.initials: JL
authors.lastname: Fernández-Torre
authors.affiliation: Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Department of Intensive Medicine, Marqués de Valdecilla University Hospital.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Hernández-Hernández
authors.affiliation: Department of Intensive Medicine, Marqués de Valdecilla University Hospital.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Rodríguez-Borregán
authors.affiliation: Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Department of Neurology, Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: González-Quintanilla
mesh_terms: D000077723:Cefepime; D002511:Cephalosporins / Q000009:adverse effects* / Q000627:therapeutic use; D003128:Coma / Q000175:diagnosis / Q000188:drug therapy*; D004569:Electroencephalography / Q000379:methods; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D013226:Status Epilepticus / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
chemical_list: D002511:Cephalosporins; D000077723:Cefepime
keywords: bilateral bispectral index; cefepime; continuous EEG monitoring; drug-induced myoclonus; myoclonic status epilepticus