美罗培南诱发1例非惊厥性癫痫持续状态

A case of Meropenem-induced nonconvulsive status epilepticus

非惊厥性癫痫持续状态是一种可由多种病因导致的综合征,使用美罗培南后诱发较罕见。现报告1例66岁男性,既往有“右侧颞叶脑梗死”病史,因“肺部感染”使用美罗培南3 d后出现发作性精神行为异常,发作间期无明显神经系统阳性症状及体征。发作期同步脑电图见反复癫痫样放电及背景活动改变。临床症状及脑电图异常在静脉使用安定后明显改善,符合非惊厥性癫痫持续状态的临床诊断标准。停用美罗培南后,短期使用抗癫痫药物后无再发。临床医生需注意因美罗培南的神经毒性诱发的非惊厥性癫痫持续状态,尤其在既往有额颞区陈旧病灶的老年患者。

Non-convulsive status epilepticus(NCSE)is a syndrome that can be caused by multiple causes.However,meropenem-induced focal NCSE have rarely been reported according to our knowledge.Here,we present an interesting case of nonconvulsive status epilepticus in a patient treated by meropenem.A 66-year-old man with a past medical history of right temporal infarction was diagnosed as lung infection.He developed paroxysmal mental and behavioral disorder for hours after administration of intravenous meropenem for 3 days while his syndrome of lung infection was greatly improved.There were no obvious positive symptoms or signs of the nervous system during the interval between episodes.Electroencephalography(EEG)were dominated by diffuse and irregular 4 to 6 Hz theta band activity and revealed rare spike-and-waves that were most prominent in recording electrodes nearby right fronto-temporal area with clinical ictal phenomena during the EEG patterns.EEG and clinical symptoms made a rapidly recovery within 5 minutes after intravenous injection of benzodiazepine,compatible with the clinical criteria for nonconvulsive status epilepticus with focal onset.Meropenem was withdrawn after the diagnosis of NCSE and no attack were observed with short-term use of antiepileptic drugs.Clinicians should pay special attention to meropenem-induced neurotoxicity,especially in elderly patients with a previous history of cerebral injury in the frontotemporal region.