A cefepime neurotoxicity case described a temporary EEG response to lorazepam, followed by recovery after several treatment changes. The sequence does not isolate lorazepam as the sole explanation for recovery.
Sharma and colleagues reported a 74-year-old woman treated for cellulitis and osteomyelitis who developed confusion, verbal perseveration, and myoclonus. Her course included chronic kidney disease and several medications, making the temporal relationship to treatment important.
Continuous EEG showed generalized periodic discharges. Lorazepam interrupted the reported EEG pattern for approximately ten hours. The clinicians also changed antiseizure treatment and discontinued cefepime after a clinical diagnosis of cefepime neurotoxicity.
Symptoms resolved within one to two days after cefepime cessation and treatment with multiple antiseizure agents. Those overlapping changes limit any attempt to identify one intervention as sufficient or necessary for the eventual improvement.
An EEG response is also a different endpoint from sustained recovery in cognition, speech, and function. The report provides a useful chronology, but not a controlled comparison establishing the relative contribution of each drug.
When confusion or abnormal movements develop during hospitalization, review newly administered drugs, renal function, EEG findings, and changes in the treatment course. Benzodiazepines may appear both as preexisting medication and as treatment for an acute neurological problem.
This case does not establish a benzodiazepine toxicity threshold or an incidence of cefepime neurotoxicity. Its value is the distinction between a short-lived electrical response and the broader clinical course after removal of a suspected offending medication.
Based on the supplied paper: Cefepime Induced Neurotoxicity in a 74 Year Old Woman. PMC8901163.