Encéphalopathies médicamenteuses, une approche pratique pour le clinicien

Drug-induced encephalopathies are frequent, even more so among patients with prescriptions for several drugs, a previous neurological disease or another cause of encephalopathy. Drugs that are most frequently involved are anti-epileptic drugs, anti-infectious agents, morphinic and chemotherapy drugs. Clinical features are variable. Thus patients can present altered consciousness ranging from stupor to comatose state. Presence of myoclonus, in particular asterixis, is highly suggestive. Brain imaging is often mandatory to exclude differential diagnosis, especially posterior encephalopathy syndrome that requires specific management. The electroencephalogram is helpful when it shows triphasic slow waves, ruling out status epilepticus. No specific treatment exists and the management consists in discontinuing, whenever possible, all medications that can cause encephalopathy.