Status epilepticus attributed to moxifloxacin in an adolescent patient with spina bifida occulta

Abstract

Dear Sirs: We present what is, to our knowledge, as of 18 June 2010, the first case published in the literature of a young patient who developed status epilepticus to moxifloxacin administration and had no history of seizures. A 23-year-old Asian woman was admitted to the hospital to undergo ileocystoplasty. She presented with a history of spina bifida, neurogenic bladder, chronic renal insufficiency and urinary tract infection. There was no prior history of seizures or epilepsy. Five days after the successful ileocystoplasty, moxifloxacin (400 mg orally daily) was prescribed for urinary tract infection. Twelve hours after the third dose, the patient experienced a generalized tonic–clonic seizure, which developed into status epilepticus lasting more than 20 min. Moxifloxacin was discontinued and switched to cefoperazone sodium and sulbactam sodium. The co-administration of phenobarbital (100 mg intramuscularly, instantly) and diazepam (10 mg intravenously, slow drip) were used to stop status epilepticus. The renal function test result was creatinine 751 μmol/L and urea 10.14 mmol/L. The blood glucose level was normal and there was no electrolyte imbalance. Computed tomography (CT) and magnetic resonance imaging (MRI) of the head were performed and neither detected any abnormalities. During the following days, the patient was prescribed intramuscular phenobarbital (100 mg every 8 h and oral valproic acid (100 mg, three times per day), and was in a generally stable condition. However, four generalized tonic–clonic seizures occurred on the 4th day, but fortunately did not develop into status epilepticus. The inter-ictal electroencephalograph (EEG) demonstrated sporadic sharp-slow waves mostly from the right frontal lobe. The patient was prescribed sodium and potassium supplement and remained seizure-free until discharge 2 weeks later. Despite the general safety of fluoroquinolones widely used as a class of broad-spectrum antibiotics, they have been rarely reported to possibly cause seizures [1]. The incidence might be enhanced by certain factors including increased age, history of seizures, renal failure and electrolyte disturbance [2]. In 2001, a summary of 15 case reports by Kushner demonstrated that two thirds of the patients developing seizures under fluoroquinolone medication were older than 50 years of age [1]. Interestingly, the young woman in this case had no seizure history or severe electrolyte imbalance. Chronic renal insufficiency seemed to be an important contributing factor for her status epilepticus, which was probably due to the use of moxifloxacin based upon the Naranjo probability scale with a score of 6 [3]. Moreover, the incident described in this letter fulfilled the definition of adverse drug event (ADE) according to the World Health Organization (WHO) criteria, and we determined the ADE to be possibly avoidable according to the method of Hallas et al. [4]. Noticeably, the adolescent presented with a history of sacral spina bifida occulta. Reports published in the literature support the finding that epilepsies occur relatively commonly L. Qiao (*) :Y. Li Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital University of Medical Sciences, Beijing 100053, People’s Republic of China e-mail: qiaoliang79@yahoo.com.cn