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

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]