Cephalosporin-Induced Neurotoxicity: Clinical Manifestations, Potential Pathogenic Mechanisms, and the Role of Electroencephalographic Monitoring

作者：Marie Francisca Grill, Rama K. Maganti · 发表于：Annals of Pharmacotherapy · 年份：2008 · DOI：10.1345/aph.1l307 · 被引用次数：200 · 研究领域：Neurological Complications and Syndromes、Antibiotics Pharmacokinetics and Efficacy、Poisoning and overdose treatments

OBJECTIVE: To review the clinical manifestations of cephalosporin-induced neurotoxicity, underlying potential mechanisms, role of electroencephalographic (EEG) monitoring, and management of neurotoxicity. DATA SOURCES: A PubMed search (1970-May 2008) was conducted using search terms such as cephalosporins, neurotoxicity, seizures, and status epilepticus. The search was not limited to the English language and yielded approximately 187 articles. STUDY SELECTION AND DATA EXTRACTION: Several case reports and case series were included to outline the salient clinical features of cephalosporin neurotoxicity. Laboratory studies investigating the potential mechanisms were also included. Reports outlining the EEG features of cephalosporin neurotoxicity were included and the role of continuous EEG monitoring was extracted. Finally, management strategies of such neurotoxicity are discussed. DATA SYNTHESIS: Cephalosporin-induced neurotoxicity may manifest in a variety of clinical presentations, ranging from simple encephalopathy or mental status changes to myoclonus, asterixis, seizures, nonconvulsive status epilepticus, as well as coma. Patients who are elderly, those with renal insufficiency, and those with prior neurologic disease may be particularly prone to the neurotoxic effects. The main mechanism of neurotoxicity appears to involve gamma-aminobutyric acid A receptor inhibition, although other mechanisms may be possible. Cephalosporin neurotoxicity may be associated with a variety ...