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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(11): s00441789267
DOI: 10.1055/s-0044-1789267
Images in Clinical Neurophysiology

Reversible ifosfamide-induced encephalopathy with bursts of triphasic waves responsive to levetiracetam

Encefalopatia reversível induzida por ifosfamida com ondas trifásicas responsiva ao levetiracetam

Autor*innen

  • Luis Eduardo Borges de Macedo Zubko 

    1   Universidade Federal do Paraná, Complexo Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil.

  • Lucas Altoé Brandão 

    1   Universidade Federal do Paraná, Complexo Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil.

  • Caio Cesar Diniz Disserol 

    1   Universidade Federal do Paraná, Complexo Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil.

  • Igor Ibrahim Nascimento 

    1   Universidade Federal do Paraná, Complexo Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil.

  • Luciano de Paola 

    2   Universidade Federal do Paraná, Complexo Hospital de Clínicas, Departamento de Neurofisiologia, Curitiba PR, Brazil.
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A 42-year-old woman with a history of metastatic osteosarcoma and chronic kidney disease presented to our emergency department due to acute altered mental status that had started two days after chemotherapy infusion with ifosfamide and etoposide. Initially, she was alert, confused, and disoriented. On the third day, she developed echolalia, perseveration, and paroxysmal events of behavioral arrest. A brain magnetic resonance imaging (MRI) scan and the laboratory work up were unremarkable. An electroencephalogram (EEG) revealed diffuse slowing of background activity and bursts of triphasic waves ([Figure 1]). The patient was managed with suspension of the ifosfamide and introduction of oral levetiracetam, which lead to improvements in the EEG and in cognition ([Figure 2]). Reversible EEG changes and antiseizure-responsive encephalopathy may be observed during ifosfamide therapy.[1] [2] [3]

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Figure 1 Three days after the onset of symptoms. Electroencephalogram (EEG) showing diffuse slowing of background activity and bursts of triphasic waves, with each burst lasting between 10 to 20 seconds.
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Figure 2 (A) Four days after the onset of symptoms. Second EEG after 1 day of levetiracetam introduction, showing partial improvement. (B) Eight days after the onset of symptoms. Third EEG, showing complete resolution.

Authors' Contributions

LEBMZ: conceptualization, data curation, methodology, and writing – original draft and editing; LAB: conceptualization, investigation, supervision, validation, visualization, and writing – review; CCDD: conceptualization, investigation, supervision, validation, visualization, and writing – review; IAN: investigation, supervision, validation, visualization, and writing – review; LP: conceptualization, formal analysis, investigation, supervision, validation, visualization, and writing – review.




Publikationsverlauf

Eingereicht: 21. Juni 2023

Angenommen: 16. Juni 2024

Artikel online veröffentlicht:
02. September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Luis Eduardo Borges de Macedo Zubko, Lucas Altoé Brandão, Caio Cesar Diniz Disserol, Igor Ibrahim Nascimento, Luciano de Paola. Reversible ifosfamide-induced encephalopathy with bursts of triphasic waves responsive to levetiracetam. Arq Neuropsiquiatr 2024; 82: s00441789267.
DOI: 10.1055/s-0044-1789267