Two elderly patients with a history of either cerebral vascular accident (CVA) or head trauma and no evidence of renal disease developed seizures while. exantema y prurito. La toxicidad neurológica, aunque rara, es más frecuente tras la administración de Imipenem/Cilastatina. La aparición de convulsiones con. Incidence Most antibiotics are CNS-safe, and neurotoxicity associated with their administration is infrequent There have been anecdotal.
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Etiologic and Clinical Aspects. Copyright American Medical Association. Two patients had seizures related to metabolic derangements. No cause was found in 1 case. The first seizure was generalized in 12 patients We found partial convulsiojes in Most patients were treated with phenytoin, which imipeenem well tolerated and effective in controlling seizures. Most seizures are generalized, and partial seizures suggest a focal cerebral lesion.
We prospectively studied the clinical and etiologic spectrum of seizures in HIV-infected patients. Any patient with prior seizures with or without relation to HIV was excluded from the study. Any patient with a first seizure during this 1-year period was examined by physicians from the Department of Neurology and followed up quarterly until death or study end. Clinical data recorded for each patient were age, sex, HIV risk factors, first seizure date, toxic drug use, latency between diagnosis of HIV infection and first seizure, stage of disease, prior anti-HIV treatments, neurologic complications related to HIV, nonneurologic complications, and seizure characteristics duration, interval between seizures, precipitating drugs, frequency, and clinical seizure type based on imipenrm International Classification of Epileptic Seizures of 7.
Examination included testing glucose and serum electrolyte levels, liver and renal function, blood cell count, serologic tests for Toxoplasma gondii and cytomegalovirus, computed tomographic or magnetic resonance imaging brain scans, and, convulsionees required, toxicologic screens, cohvulsiones and cerebrospinal fluid studies biochemical tests, serologic tests for syphilis and T gondii, Gram stain, cultures for Cryptococcus neoformans and Mycobacteriumstains for acid-fast Bacillusand polymerase chain reaction for herpes simplex virus.
Human immunodeficiency virus risk factors were intravenous drug use IVDU in 10 patients 5 men convulsionds, homosexual activity in 4 all menand heterosexual transmission in 3 1 woman. At the time of first seizure, 14 Mean follow-up was 5.
Drug toxicity was considered a definite or probable cause when the time was close between use of the drug and the seizure. Metabolic derangements hypoglycemia and hypomagnesemia were observed in 2 patients Toxic-metabolic factors were thus the cause of the seizure in 10 patients No cause was found convhlsiones 1 patient, despite a thorough examination.
First seizure was generalized in 12 patients During follow-up, the 2 patients with initial simple partial seizure evolved to generalized seizure. All 17 patients had a generalized seizure at some time. All generalized seizures were tonic-clonic, except for 1 patient who had myoclonic seizures.
No complex partial seizures were observed. Seizures were refractory to therapy in 3 patients Two untreated patients had cerebral TXP: Carbamazepine therapy was discontinued in both patients because of adverse effects severe skin reaction and ataxia and was changed to phenytoin.
No serious adverse effects were observed in patients who received phenytoin, except in 1 patient imipebem ataxia and nystagmus because the dosage was too high. Seizures were well controlled with treatment.
A cause was identified in most of our patients convulsones Generalized tonic-clonic seizures were the most common, and a focal seizure suggested a structural cerebral lesion. In our series, seizure was never the presenting feature of HIV infection. Patients who had seizures responded well to therapy.
The risk of seizures among the carbapenems: a meta-analysis.
The reported higher percentages are possibly because of the inclusion of only inpatients in the advanced disease stages and a longer follow-up than in our study. We studied patients both outpatients and inpatients for only 1 year; if the inclusion period had been longer, the occurrence might have been higher.
Since the number of HIV-infected patients with first seizure in our study is relatively low, iimipenem characterization is limited. In other reports, imopenem transmission was the most common risk factor. Prior to their first seizure, 14 patients Previous studies have ranged convulsionez In the literature, seizures have been reported as a presenting manifestation of HIV-related disease in 3.
We were able to identify the cause of seizure in The HIV stage was less advanced in those with no identifiable cause than in those with an identifiable cause. In our series, we were unable to identify a presumed cause in only 1 patient in whom the HIV infection alone was the presumed cause.
Only 1 patient with cerebral TXP had refractory seizures. One patient had simple partial seizures imipenwm PML. This disease was first described as a cause of seizures in Convulsionez variety of other causes have been associated with HIV-infected patients who have seizures infection, neoplasm, and stroke38 – convlsiones1323 – 26 but we did not see these causes in our patients.
Unlike previous studies 310 according to our study, toxic-metabolic factors accounted for more than half Surprisingly, in series with larger groups of patients, 913 no seizures caused by toxic-metabolic factors were observed. The cause of seizures in 2 patients convulsiojes hypoglycemia and hypomagnesemia. Hypomagnesemia can induce epileptic seizures, 2728 and Van Paesschen et al 8 emphasize metabolic causes as important in HIV-infected patients. None of the patients with status epilepticus had these disorders.
The cause of 1 partial seizure dysphasiawhich evolved to a generalized seizure, was hypomagnesemia. Neurotoxicity due to use of zidovudine has been long recognized as a cause of epileptic seizures. In 1 patient, convulslones produced a GTC seizure, a well-known adverse effect. Calcium and magnesium levels in 1 patient were normal. Seizures directly related to substance use, abuse, and withdrawal are increasingly common.
The risk of seizures among the carbapenems: a meta-analysis.
A third patient had a GTC seizure related to medazepam hydrochloride treatment withdrawal. Similar to other reports, 38 we observed status epilepticus in 3 patients Van Paesschen et al 8 report a higher occurrence of status epilepticus in patients with IVDU than in other risk factor groups. A single seizure occurred in 4 patients In 3 patients While seizures tended imipendm be well controlled with the use of phenytoin, the duration of follow-up is insufficient to estimate effectiveness.
Thus, in contrast to other authors, 14 we did not find a relationship between status epilepticus and poor outcome. Future extensive prospective studies with longer follow-up and pathological examination are needed to determine the significance of epileptic seizures in HIV-infected patients. First seizure in adults: Neurological complications of acquired immunodeficiency syndrome: N Engl J Med. AIDS-associated progressive multifocal leukoencephalopathy revealed by new-onset seizures.
Progressive multifocal leukoencephalopathy in AIDS: HIV-related encephalitis presenting as convulsant disease. Lethal neurotoxicity associated to azidothymidine therapy. J Neurol Neurosurg Psychiatry. Seizure after zidovudine overdose. Convulsiones inducidas por imipenem en una paciente HIV-positiva [letter].
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