Hepatic Coma: The Electroencephalographic Pattern

Bickford, Reginald G.; Butt, Hugh R.

doi:10.1172/jci103134

Cited by 263 publications

(136 citation statements)

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“…In the current study the majority of alpha and theta comas originated in patients with cardiorespiratory arrest, while spindle comas originated in cases of intoxication by poison or medications. Comparable to the results found in other publications 6,32 , spindle comas had a better prognosis than alpha and theta comas.…”

Section: Resultssupporting

confidence: 52%

“…This group basically comprises patients with hepatic encephalopathy due to cirrhosis and who are waiting for liver transplantation. The EEGs of one fifth of these patients, apart from having slow activity, presented triphasic waves 6,29 .…”

Section: Resultsmentioning

confidence: 92%

“…The different patterns of EEG obtained in emergency patients, although nonspecific, can often be correlated with the etiology of diseases of the central nervous system such as trauma 4 , vascular injury and anoxic-ischemic injury due to cardiorespiratory arrest 5 . In hepatic encephalopathy 6,7 , Creutzfeldt-Jakob disease 8 , non-convulsive status epilepticus [9][10][11][12][13][14][15] and herpes simplex encephalitis 16 , EEG is decisive for diagnosis and thus guides therapy and gives an indication of the prognosis.…”

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confidence: 99%

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Emergency EEG: study of survival

Borges

Botós

Bastos

et al. 2010

Arq. Neuro-Psiquiatr.

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Objective: To determine the survival rate according to the main findings of emergency electroencephalography (EEGs) of patients treated in a tertiary hospital. Method: In this prospective study, the findings of consecutive emergency EEGs performed on inpatients in Hospital de Base in São José do Rio Preto, Brazil were correlated with survival utilizing KaplanMeyer survival curves. results: A total of 681 patients with an average age of 42 years old (1 day to 96 years) were evaluated, of which 406 were male. The main reasons for EEGs were epileptic seizures (221 cases), hepatic encephalopathy [116 cases of which 85 (73.3%) were men, p-value=0.001], status epilepticus (104 cases) and impaired consciousness (78 cases). The underlying disease was confirmed in 578 (84.3%) cases with 119 (17.5%) having liver disease [91 (76.0%) were men, p-value=0.001], 105 (15.4%) suffering strokes, 67 (9.9%) having metabolic disorders, 51 (7.5%) central nervous system infections and 49 (7.2%) epilepsy. In the three months following EEG, a survival rate of 75% was found in patients with normal, discreet slow activity or intermittent rhythmic delta activity EEGs, of 50% for those with continuous delta activity and generalized epileptiform discharges, and of 25% for those with burst-suppression, diffuse depression, and in alpha/theta-pattern coma. Death was pronounced immediately in patients with isoelectric EEGs. conclusion: The main findings of EEGs, differentiated different survival rates and are thus a good prognostic tool for patients examined in emergencies. Key words: EEG, emergency, prognosis, probability of survival.EEG de urgência: taxa de sobrevivência rEsuMO Objetivo: Determinar a taxa de sobrevivência (TS), segundo os principais achados de eletrencefalograma de urgência (E-EEG), dos pacientes atendidos nas emergências de hospital de alta complexidade. Método: Estudo prospectivo, por ordem de chegada, da correlação entre os achados de E-EEG, feitos nos pacientes à beira do leito, com TS, utilizando-se as curvas de sobrevidas de Kaplan Meyer no Hospital de Base de São José do Rio Preto, São Paulo/Brasil. resultados: Foram estudados 681 pacientes, dos quais 406 (59,6%) masculinos, com idade média de 42 anos (1 dia a 96 anos). As principais motivações para o E-EEG foram crises epilépticas (221 casos), encefalopatia hepática [(116 casos, dos quais 85 masculinos (73,3%), p= 0,001]; estado de mal epiléptico 104 e rebaixamento de consciência 78. O diagnóstico da doença de base foi confirmado em 578 (84,3%), sendo 119 (17,5%) hepatopatia, dos quais 91 (76,%) masculinos, p= 0,001; 105 (15,4%) acidente vascular encefálico; 67 (9,9%) distúrbio metabólico; 51 (7,5%) infecção do sistema nervoso central e 49 (7,2%) epilepsia. TS de 75% nos três primeiros meses foi encontrada nos pacientes com

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Section: Resultssupporting

confidence: 52%

Section: Resultsmentioning

confidence: 92%

mentioning

confidence: 99%

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Emergency EEG: study of survival

Borges

Botós

Bastos

et al. 2010

Arq. Neuro-Psiquiatr.

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“…With regard to the morphology, most investigators use many of the criteria described by Bickford and Butt. 1 More recently, Sundaram and Blume 10 provided details of the electrographic characteristics of the pattern.…”

Section: Discussionmentioning

confidence: 99%

Triphasic Waves During Post-Ictal Stupor

Ogunyemi

1996

Can. j. neurol. sci.

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Background: The term, "triphasic wave" originally described an EEG pattern believed to be a marker for a specific stage of hepatic coma. For 4 decades, the diagnostic and prognostic specificity of the pattern remains controversial. Its pathophysiology also continues to be elusive. Methods: EEG recordings were obtained in three patients known or suspected to have primary generalized epilepsy. In 2 patients, the EEGs were part of long-term monitoring using simultaneous video-EEG telemetry. For the third patient, the EEG was secured only during the post-ictal unconsciousness. These 3 patients were specifically selected because of the presence of triphasic waves in their EEGs. Results: Triphasic waves were observed in the EEG of the 3 patients only during post-ictal unconsciousness. The pattern was transient, being preceded by generalized suppression and delta slow waves and followed by theta activities. Alpha rhythms supervened when the patients became fully alert. Conclusion: A post-ictal state should be considered in unconscious patients with triphasic EEG waves. RESUME: Ondes triphasiques pendant la stupeur postcritique. Introduction: On parlait initialement d'onde triphasique pour decrire un motif EEG qu'on croyait etre un marqueur d'un stade specifique du coma hepatique. Pendant 4 decennies, la specificite diagnostique et pronostique de ce motif sont demeurees un sujet de controverse. Sa pathophysiologic demeure egalement obscure. Methodes: Nous avons obtenu des enregistrements EEG chez trois patients avec un diagnostic certain ou soup$onne d'epilepsie generalisee primaire. Chez 2 patients, l'EEG faisait partie du suivi a long terme associe a la telemesure video-EEG. Chez le troisieme patient, l'EEG a ete enregistre seulement pendant la peYi-

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“…Triphasic waves (TWs) on the EEG were described more than five decades ago and are usually attributed to a metabolic encephalopathy. 3,4 The association of TWs with hepatic encephalopathy is well known. In the past, they were thought of as being pathognomonic of hepatic coma.…”

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confidence: 99%

Triphasic Waves Versus Nonconvulsive Status Epilepticus: EEG Distinction

Boulanger

Deacon

Lécuyer

et al. 2006

Can. j. neurol. sci.

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The electroencephalogram (EEG) is a very useful tool for the evaluation of patients with altered levels of consciousness and coma. 1,2 It permits one to rule out status epilepticus, confirm a diffuse or focal process and may orient the clinician towards an underlying etiology. Triphasic waves (TWs) on the EEG were described more than five decades ago and are usually attributed to a metabolic encephalopathy. 3,4 The association of TWs with hepatic encephalopathy is well known. In the past, they were thought of as being pathognomonic of hepatic coma. We now know that TWs are associated with a wide variety of disorders (metabolic and non-metabolic) affecting the brain diffusely. 5,6 Triphasic waves are not epileptiform per se and are usually not associated with seizures. The TWs and generalized periodic or continuous epileptiform discharges occurring in generalized nonconvulsive status epilepticus (GNCSE) may share ABSTRACT: Background: Triphasic waves (TWs) and generalized nonconvulsive status epilepticus (GNCSE) share morphological features that may create diagnostic ambiguity. Objective: To describe electroencephalographic differences between TWs and GNCSE. Methods: We retrospectively compared the electroencephalograms (EEGs) of two groups of patients presenting with decreased level of consciousness; those with TWs associated with metabolic encephalopathy and those with GNCSE. We studied the following: demographics, etiology and EEG morphological features. All EEGs were classified blindly (TWs or GNCSE) by two expert EEGers. Agreement between experts and concordance with clinical diagnosis were measured. Results: We analysed 87 EEGs (71 patients) with TWs and 27 EEGs (13 patients) with GNCSE. Agreement between experts and concordance with clinical diagnosis were excellent. When compared to TWs, epileptiform discharges associated with GNCSE had a higher frequency (mean=2.4Hz vs 1.8Hz) (p<0.001), a shorter duration of phase one (p=0.001), extra-spikes components (69% vs 0%) (p<0.001) and less generalized background slowing (15.1% vs 91.1%) (p<0.001). Amplitude predominance of phase two was common with TWs (40.8% vs 0%) (p=0.01). Lag of phase two was absent in all cases of GNCSE but present in 40.8% of patients with TWs. Noxious or auditory stimulation frequently increased the TWs (51%) while it had no effect on the epileptiform pattern (p=0.008). Conclusions: Certain EEG morphological criteria and the response to stimulation are very helpful in distinguishing TWs from GNCSE. Tous les patients avaient une altération de la conscience. Les caractéristiques suivantes furent analysées: âge, étiologie sous-jacente et plusieurs caractéristiques morphologiques de l'EEG. Tous les EEGs ont été classifiés à l'aveugle (OT ou SEGNC) par deux électroencéphalographistes experts et l'exactitude par rapport au diagnostic clinique a été évaluée de même que la concordance entre les deux experts. Résultats: 87 EEGs (71 patients) avec OT et 27 EEGs (13 patients) avec SEGNC ont été analysés. La concordance entre les experts et l'exacti...

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Hepatic Coma: The Electroencephalographic Pattern

Cited by 263 publications

References 2 publications

Emergency EEG: study of survival

Emergency EEG: study of survival

Triphasic Waves During Post-Ictal Stupor

Triphasic Waves Versus Nonconvulsive Status Epilepticus: EEG Distinction

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