Generalized Periodic Discharges With and Without Triphasic Morphology

Alkhachroum, Ayham; Al-Abri, Haifa; Sachdeva, Alok; Maturu, Sarita; Waldron, Jennifer J.; Wang, Han; Rizvi, Macym; Vaca, Guadalupe Fernandez‐Baca; Lüders, Hans

doi:10.1097/wnp.0000000000000441

Cited by 14 publications

(14 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This was similar to a study examining the IRA for EEGs of comatose patients in general [21], as well as a study specifically examining GPDs that found that among 20 patients, the IRA for 'triphasic morphology' was only fair (κ of 0.33) [22]. In a retrospective cohort study of 92 patients with GPDs, the IRA for 'triphasic morphology' was "substantial," with a κ of 0.67 [23]. However, this study utilized only two raters, where the prior IRA study for GPDs used 11 to rate EEGs; this difference could have contributed to the disparity in the IRA.…”

Section: Updated Terminology and Interrater Agreementsupporting

confidence: 80%

“…Variables with a statistically significant risk of having seizures included focality on EEG, interburst suppression, history of epilepsy, an abnormal neuroimaging test, and generalized pattern without triphasic morphology. GP-D+TW had a statistically significant decreased risk of seizures [23]. However, others have noted that their definition of GP-D+TW does not appear in line with ACNS guidelines and this may have influenced their findings [30].…”

Section: Nonconvulsive Status Epilepticus and Seizuresmentioning

confidence: 93%

See 1 more Smart Citation

Generalized periodic discharges with triphasic morphology

Hartshorn

Foreman

2019

J Neurocrit Care

View full text Add to dashboard Cite

Generalized periodic discharges (GPDs) are electroencephalographic (EEG) waveforms that can be seen in a wide array of encephalopathies. By definition, they are repeated and generalized waveforms with relatively uniform morphology and duration, with a quantifiable interdischarge interval between consecutive waveforms, and recurrence of the waveform at nearly regular intervals (Fig. 1) [1]. There are different theories for their etiology and pathophysiology. Early work suggested that GPDs were due to widespread cortical destruction with relative sparing of white Generalized periodic discharges (GPDs) with triphasic morphology are an electroencephalographic (EEG) pattern traditionally associated with encephalopathy and coma, although they have been observed in a wide array of neurological disorders. The clinical significance of these waveforms and their relationship to seizures and prognosis has been debated, and differentiation between interictal patterns, patterns associated with seizures, and patterns representing nonconvulsive status epilepticus can at times be a challenge. The most established literature suggests that GPDs, including those with triphasic morphology, are associated with the development of electrographic seizures, but that in the absence of clinical information, distinguishing waveforms based on morphology alone may not be clinically useful. Recent work has advocated for a more proactive approach in evaluating GPDs with triphasic morphology. Further studies of nonsedating antiseizure drugs in patients with GPDs with triphasic morphology that incorporate continuous EEG monitoring will be useful in tailoring therapy to optimize long-term clinical outcomes and recovery.

show abstract

Section: Updated Terminology and Interrater Agreementsupporting

confidence: 80%

Section: Nonconvulsive Status Epilepticus and Seizuresmentioning

confidence: 93%

Generalized periodic discharges with triphasic morphology

Hartshorn

Foreman

2019

J Neurocrit Care

View full text Add to dashboard Cite

show abstract

“…We added 13 other articles. [60][61][62][63][64][65][66][67][68][69][70][71][72] Therefore, we analyzed a total of 21 investigations. 31,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] Bibliographic characteristics and description of the EEG features reported in this studies can be found in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Atypical or Typical Triphasic Waves—Is There a Difference? A Review

Fernández‐Torre

Kaplan

2021

Journal of Clinical Neurophysiology

View full text Add to dashboard Cite

The entity of triphasic waves (TWs) and TW encephalopathy has derived from the subjective art of EEG interpretation. Indeed, there are few if any guidelines regarding many different aspects of TWs. The authors seek to shed light on the nature and the diagnostic characteristics of various types of TWs, differentiating "typical" from "atypical" forms. The authors conclude that morphologies in the form of bursts of well-formed, smoothly contoured, negative-positive-negative, bilateral, symmetrical and synchronous, regular, reactive, periodic or rhythmic, 1.5 to 2.0 Hz, fronto-central, triphasic complexes with frontooccipital lag meet the criteria for typical TWs and are highly suggestive of toxic-metabolic encephalopathies. These are most frequently hepatic, uremic, or sepsis-associated encephalopathies with multi-organ failure. In such cases, atypical TWs (frontopolar or parieto-occipital maximum, negative-positive or negativepositive-negative, asymmetric and asynchronous, unreactive, irregular, multifocal, continuous with spatiotemporal evolution, sharper and without fronto-occipital/occipito-frontal lag, or triphasic delta waves) are rarely seen. Atypical TWs are encountered in Angelman syndrome, toxic encephalopathies, hyperthyroidism/hypothyroidism, Hashimoto encephalopathy, nonconvulsive status epilepticus, dementia, sepsis-associated encephalopathy, cerebrovascular disorders, and certain boundary syndromes. Investigations describing TWs with uncommon etiologies revealed few with typical TWs, suggesting that the term "TWs" has been overused in the past. Triphasic waves arise from the interaction of multiple factors including toxic, metabolic, infectious, and structural disorders that affect circuits between thalamus and cortex. The patient's metabolic status, presence of potentially neurotoxic drugs, cerebral atrophy, white matter disease, dementia, or seizures help differentiate typical from typical TWs. Future studies will determine whether this dichotomy is heuristically and clinically helpful.

show abstract

“…Triphasic waves may assume an ictal pattern and be associated with seizures. This is particularly true in high-risk patients with a focality on EEG, inter-burst suppression, a history of epilepsy, and abnormal neuroimaging findings (72). Various authors have suggested an algorithm to distinguish ictal appearing TW pattern to facilitate correct therapeutic intervention and avoid unnecessary use of ASMs (69).…”

Section: Generalized Periodic Patterns With Triphasic Morphologymentioning

confidence: 99%

Adult Critical Care Electroencephalography Monitoring for Seizures: A Narrative Review

2022

View full text Add to dashboard Cite

Electroencephalography (EEG) is an important and relatively inexpensive tool that allows intensivists to monitor cerebral activity of critically ill patients in real time. Seizure detection in patients with and without acute brain injury is the primary reason to obtain an EEG in the Intensive Care Unit (ICU). In response to the increased demand of EEG, advances in quantitative EEG (qEEG) created an approach to review large amounts of data instantly. Finally, rapid response EEG is now available to reduce the time to detect electrographic seizures in limited-resource settings. This review article provides a concise overview of the technical aspects of EEG monitoring for seizures, clinical indications for EEG, the various available modalities of EEG, common and challenging EEG patterns, and barriers to EEG monitoring in the ICU.

show abstract

Generalized Periodic Discharges With and Without Triphasic Morphology

Cited by 14 publications

References 13 publications

Generalized periodic discharges with triphasic morphology

Generalized periodic discharges with triphasic morphology

Atypical or Typical Triphasic Waves—Is There a Difference? A Review

Adult Critical Care Electroencephalography Monitoring for Seizures: A Narrative Review

Contact Info

Product

Resources

About