TY - JOUR
T1 - Significance of triphasic waves in patients with acute encephalopathy
T2 - A nine-year cohort study
AU - Sutter, Raoul
AU - Stevens, Robert D.
AU - Kaplan, Peter W.
N1 - Funding Information:
R. Sutter is supported by the Research Fund of the University of Basel, the Scientific Society Basle, and the Gottfried Julia Bangerter-Rhyner Foundation. P.W. Kaplan has no relevant conflicts of interest except authorship in several books on EEG.
PY - 2013/10
Y1 - 2013/10
N2 - Objective: Triphasic waves (TWs) are a frequent electroencephalography (EEG) finding in encephalopathy, yet their origin and prognostic significance are not well understood. The aim of this study was to determine the clinical and EEG characteristics in encephalopathic patients with TWs. We hypothesized that specific EEG characteristics are predictive of outcome. Methods: Consecutive adult encephalopathic patients with TWs on EEG and neuroimaging were included. EEG analysis included semiquantitative evaluation of TWs, background activity, and EEG reactivity. The study endpoint was death. Results: Over a nine-year period, 105 patients with TWs were included. Common abnormalities on neuroimaging were white matter lesions (60%) and cerebral atrophy (59%). Pathologic conditions included infections (56%), renal (50%) and liver insufficiency (12%), and respiratory failure (20%). Mortality was 20%. Absent EEG background reactivity and respiratory failure were independently associated with death (OR 3.73, 95%CI 1.08-12.80, p= 0.037 and OR 6.47, 95%CI 1.98-21.12, p= 0.02). Conclusions: These results suggest that TWs are a marker of structural brain disease coupled with toxic-metabolic perturbations, and that etiologies or underlying pathologies were not predictive for outcome while non-reactive EEG was independently associated with death. Significance: In contrast to clinical, EEG and neuroimaging findings, non-reactive EEG patterns predicted death in encephalopathic patients with TWs.
AB - Objective: Triphasic waves (TWs) are a frequent electroencephalography (EEG) finding in encephalopathy, yet their origin and prognostic significance are not well understood. The aim of this study was to determine the clinical and EEG characteristics in encephalopathic patients with TWs. We hypothesized that specific EEG characteristics are predictive of outcome. Methods: Consecutive adult encephalopathic patients with TWs on EEG and neuroimaging were included. EEG analysis included semiquantitative evaluation of TWs, background activity, and EEG reactivity. The study endpoint was death. Results: Over a nine-year period, 105 patients with TWs were included. Common abnormalities on neuroimaging were white matter lesions (60%) and cerebral atrophy (59%). Pathologic conditions included infections (56%), renal (50%) and liver insufficiency (12%), and respiratory failure (20%). Mortality was 20%. Absent EEG background reactivity and respiratory failure were independently associated with death (OR 3.73, 95%CI 1.08-12.80, p= 0.037 and OR 6.47, 95%CI 1.98-21.12, p= 0.02). Conclusions: These results suggest that TWs are a marker of structural brain disease coupled with toxic-metabolic perturbations, and that etiologies or underlying pathologies were not predictive for outcome while non-reactive EEG was independently associated with death. Significance: In contrast to clinical, EEG and neuroimaging findings, non-reactive EEG patterns predicted death in encephalopathic patients with TWs.
KW - Behavioral disorder
KW - EEG patterns
KW - Encephalopathy
KW - Neurocritical care
KW - Outcome
KW - Triphasic waves
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U2 - 10.1016/j.clinph.2013.03.031
DO - 10.1016/j.clinph.2013.03.031
M3 - Article
C2 - 23684126
AN - SCOPUS:84883051539
SN - 1388-2457
VL - 124
SP - 1952
EP - 1958
JO - Clinical Neurophysiology
JF - Clinical Neurophysiology
IS - 10
ER -