Ifosfamide chemotherapy and nonconvulsive status epilepticus: case report and review of the literature.

Abstract

We present a patient with peritoneal carcinosarcoma who was treated with the alkylating agent ifosfamide and experienced a rapid decline in mental status. Electroencephalogram (EEG) displayed generalized periodic epileptiform discharges, which raised suspicion for nonconvulsive status epilepticus (NCSE). Following administration of midazolam, the patient's clinical condition and EEG improved. We review the 8 documented cases of ifosfamide-induced NCSE, and demonstrate the similarity in clinical features when compared with ifosfamide neurotoxicity that is not classified as NCSE. EEG findings suggesting an ictal pattern are subtle and heterogeneous, but they are essential for a diagnosis. Since it is unlikely that EEGs are uniformly obtained in instances of ifosfamide neurotoxicity, many cases of NCSE may go unrecognized.

• Authors: Daniel Taupin, Rikki Racela, Daniel Friedman
• Journal: Clinical EEG and neuroscience (Clin EEG Neurosci) Vol. 45 Issue 3 Pg. 222-5 (Jul 2014) ISSN: 1550-0594 [Print] United States
• PMID: 24151171 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Midazolam
• Ifosfamide

Topics

• Carcinosarcoma (drug therapy)
• Cerebral Cortex (drug effects, physiopathology)
• Diagnosis, Differential
• Electroencephalography (drug effects)
• Epilepsy, Generalized (chemically induced, diagnosis, drug therapy)
• Evoked Potentials (drug effects)
• Fatal Outcome
• Female
• Humans
• Ifosfamide (adverse effects, therapeutic use)
• Midazolam (therapeutic use)
• Middle Aged
• Peritoneal Neoplasms (drug therapy)
• Signal Processing, Computer-Assisted