Seizures as adverse events of antibiotic drugs

Sutter, Raoul; Rüegg, Stephan; Tschudin‐Sutter, Sarah

doi:10.1212/wnl.0000000000002023

Cited by 192 publications

(151 citation statements)

References 59 publications

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“…Risk of minor adverse events such as mild headache, tinnitus, cutaneous discomfort, neck muscle contraction, nausea, light headedness or syncope, unilateral eye pain and lacrimation remains <5%. To put this into perspective, the risk of seizures with penicillins and carbapenem drugs is up to 5%63 and increases further with predisposing factors. To date, meta-analyses of published treatment trials of TMS64–66 have been reassuring and support safe use of TMS in patients and healthy volunteers.…”

Section: Safety Considerationsmentioning

confidence: 99%

Interrogating cortical function with transcranial magnetic stimulation: insights from neurodegenerative disease and stroke

Agarwal

Koch

Hillis

et al. 2018

J Neurol Neurosurg Psychiatry

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Transcranial magnetic stimulation (TMS) is an accessible, non-invasive technique to study cortical function in vivo. TMS studies have provided important pathophysiological insights across a range of neurodegenerative disorders and enhanced our understanding of brain reorganisation after stroke. In neurodegenerative disease, TMS has provided novel insights into the function of cortical output cells and the related intracortical interneuronal networks. Characterisation of cortical hyperexcitability in amyotrophic lateral sclerosis and altered motor cortical function in frontotemporal dementia, demonstration of cholinergic deficits in Alzheimer's disease and Parkinson's disease are key examples where TMS has led to advances in understanding of disease pathophysiology and potential mechanisms of propagation, with the potential for diagnostic applications. In stroke, TMS methodology has facilitated the understanding of cortical reorganisation that underlie functional recovery. These insights are critical to the development of effective and targeted rehabilitation strategies in stroke. The present review will provide an overview of cortical function measures obtained using TMS and how such measures may provide insight into brain function. Through an improved understanding of cortical function across a range of neurodegenerative disorders, and identification of changes in neural structure and function associated with stroke that underlie clinical recovery, more targeted therapeutic approaches may now be developed in an evolving era of precision medicine.

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Section: Safety Considerationsmentioning

confidence: 99%

Interrogating cortical function with transcranial magnetic stimulation: insights from neurodegenerative disease and stroke

Agarwal

Koch

Hillis

et al. 2018

J Neurol Neurosurg Psychiatry

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show abstract

“…5 As such, most reports of seizures associated with these agents emerge from their use in high doses (often in the treatment of CNS infections) or in renal failure. 6 Carbapenems more readily penetrate the CNS and their use is associated with an increased seizure risk compared with non-carbapenem antibiotics. 7 Among the carbapenems, imipenem is generally thought to have the highest risk.…”

Section: Beta-lactamsmentioning

confidence: 99%

“…13 Seizures are rare but have been reported, particularly with ciprofloxacin in the context of other susceptibility factors. 6 Macrolides, tetracyclines, aminoglycosides and glycopeptides have not been associated with seizures. 6 …”

Section: Other Antimicrobialsmentioning

confidence: 99%

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Drugs that lower the seizure threshold

Hitchings

2016

Adverse Drug Reaction Bulletin

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SummaryDrugs with potential to lower the seizure threshold are numerous and diverse. Whether they contribute to clinically overt seizures depends on the dosage in which they are taken, the time-course of their effects, and the susceptibility of the patient. Crucially, however, their contribution to seizure risk is potentially modifiable. The clinical features of seizures may include abnormalities of consciousness, movement, sensation, behaviour and autonomic function. Epilepsy is the enduring tendency to experience seizures. Seizures and the seizure thresholdThe seizure threshold describes the minimum intensity of a stimulus required to induce a seizure. It is clinically evident in the context of electroconvulsive therapy, but is otherwise primarily an experimental phenomenon, in which seizures are induced by electrical or chemical stimuli (e.g. with pentylenetetrazole). It is often evaluated during drug development to quantify the extent to which a drug prevents seizures (if this is the intended therapeutic effect) or induces them (as an unwanted effect). As a broader concept, it is useful in clinical practice as a framework to help understand the complex interplay between the patient, their medicines, and their risk of seizures. Pathophysiology and pharmacologySeizures occur when there is an excess of excitatory activity relative to inhibitory activity. Glutamate and gamma-aminobutyric acid (GABA) are, respectively, the principle excitatory and inhibitory neurotransmitters in the central nervous system (CNS). Glutamate acts via N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid (AMPA) and kainite receptors to cause an influx of sodium and calcium ions, favouring depolarisation. GABA acts primarily through GABAA receptors to cause an influx of chloride ions, inducing hyperpolarisation. The mechanisms of action of antiepileptic drugs are not universally understood, but include inference with sodium (e.g. phenytoin, carbamazepine, lamotrigine) and calcium channels (e.g. ethosuxamide); enhancing the effects of GABA

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“…A number of studies have reported neurotoxicity of imipenem, especially in patients with brain injury [3, 4]. More recently, several authors have reported neurotoxicity with cefepime.…”

mentioning

confidence: 99%