Nonconvulsive status epilepticus due to ifosfamide

Ann Pharmacother. 2006 Feb;40(2):332-5. doi: 10.1345/aph.1G363. Epub 2006 Jan 31.


Objective: To report 2 cases of nonconvulsive status epilepticus (NCSE) following infusion of ifosfamide.

Case summaries: Two patients who received ifosfamide-containing chemotherapy developed NCSE. One woman received ifosfamide 1000 mg/m2 (1 h infusion on days 1-5); confusion, lethargy, and speech deterioration developed on day 3. The second patient developed similar symptoms on day 3 of treatment with 2500 mg/m2. Both patients responded to intravenous administration of diazepam 10 mg and were given levetiracetam as maintenance therapy.

Discussion: The severity and presentation of central nervous system toxicity due to ifosfamide varies greatly and involves a spectrum ranging from subclinical electroencephalogram changes to coma. NCSE, an epileptic disorder in which typical convulsive activity is absent, has previously been reported in only 4 patients receiving ifosfamide. Levetiracetam may be used for maintenance antiepileptic therapy after diazepam administration.

Conclusions: Among the many presentations of ifosfamide neurotoxicity, clinicians should consider NCSE as a possible explanation for changes in consciousness in a patient receiving this agent. An objective causality assessment by use of the Naranjo probability scale revealed that NCSE due to ifosfamide was probable.

Publication types

  • Case Reports

MeSH terms

  • Anticonvulsants / therapeutic use
  • Antineoplastic Agents, Alkylating / administration & dosage
  • Antineoplastic Agents, Alkylating / adverse effects*
  • Antineoplastic Agents, Alkylating / therapeutic use
  • Diazepam / therapeutic use
  • Female
  • Humans
  • Ifosfamide / administration & dosage
  • Ifosfamide / adverse effects*
  • Ifosfamide / therapeutic use
  • Levetiracetam
  • Middle Aged
  • Neoplasms / drug therapy
  • Piracetam / analogs & derivatives
  • Piracetam / therapeutic use
  • Status Epilepticus / chemically induced*
  • Status Epilepticus / drug therapy


  • Anticonvulsants
  • Antineoplastic Agents, Alkylating
  • Levetiracetam
  • Diazepam
  • Ifosfamide
  • Piracetam