Triphasic waves on electroencephalogram in patients with encephalopathy and their diagnosis significance. A review

2021 ◽  
pp. 38-43
Author(s):  
E. A. Baranova ◽  
M. V. Sinkin
Keyword(s):  
Status Epilepticus ◽  
High Amplitude ◽  
Subcortical White Matter ◽  
Nonconvulsive Status Epilepticus ◽  
Metabolic Disturbances ◽  
Metabolic Encephalopathy ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Low Amplitude ◽  
Eeg Pattern

Triphasic waves are high-amplitude (>70 µV) positive sharp transients preceded and followed by relatively low-amplitude negative waves. The distribution is generalized and tends to have a repetition rate of approximately 1 to 2 Hz. This EEG-pattern is traditionally associated with hepatic encephalopathy, although they have been observed in a wide array of neurological disorders including subcortical white-matter disease, infections, metabolic disturbances and nonconvulsive status epilepticus.American Clinical Neurophysiology Society suggested Standardized Critical Care EEG Terminology (2012). One of the goals was to eliminate terms with clinical connotations, such as ‘triphasic waves’, a term that implies a metabolic encephalopathy with no relationship to seizures for many clinicians. The term ‘triphasic waves’ was replaced by ‘Generalized periodic discharges (GPDs) with triphasic morphology’. The clinical significance ofthese waveforms and their relationship with seizures and prognosis has been debated, and differentiation between interictal patterns, patternsassociated with seizures, and the patterns representing nonconvulsive status epilepticus have been concluded to be a challenge. In cases of uncertainty, the decision to treat should follow on a thorough evaluation with a continuous EEG monitoring and using a short-acting benzodiazepine or non-sedating antiepileptic drugs in order to discern the effects of the pattern on the patient’s clinical exam and EEG.

scholarly journals Nonconvulsive Status Epilepticus Complicating Epstein-Barr Virus Encephalitis in a Child

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Filippo Greco ◽  
Maria Donatella Cocuzza ◽  
Pierluigi Smilari ◽  
Giovanni Sorge ◽  
Lorenzo Pavone
Keyword(s):  
Status Epilepticus ◽  
Epstein Barr Virus ◽  
Early Recognition ◽  
Central Nervous System Infection ◽  
Nonconvulsive Status Epilepticus ◽  
Barr Virus ◽  
Appropriate Treatment ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Epstein Barr

Children with acute encephalopathy show prolonged electrographic seizure activity consistent with nonconvulsive status epilepticus (NCSE). Pediatric NCSE is a heterogeneous clinical entity with poor outcome and different etiologies, including central nervous system infection, stroke, toxic-metabolic syndrome, and epileptic syndrome. We report a 4-year-old girl with seizure and behavioral changes in whom the analysis of cerebrospinal fluid by polymerase chain reaction was positive for Epstein-Barr virus. We emphasize the importance of electroencephalography (EEG), and particularly, of continuous EEG monitoring for early recognition and appropriate treatment of this condition.

Nonconvulsive Status Epilepticus

2017 ◽  
Author(s):  
Frank W Drislane ◽  
Susan T Herman ◽  
Peter W Kaplan
Keyword(s):  
Status Epilepticus ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Nonconvulsive Status Epilepticus ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Absence Status ◽  
Continuous Eeg Monitoring ◽  
Better Than ◽  
Partial Status

The clinical presentation and encephalographic (EEG) findings of nonconvulsive status epilepticus (NCSE) can be complicated, making diagnosis difficult. There are generalized (e.g., absence status) and focal (e.g., aphasic status, complex partial status) forms. Some patients are responsive but have cognitive or other neurologic deficits; others are less responsive or even comatose. Increasingly, the diagnosis of NCSE is considered in intensive care unit patients. Here, without clinical signs of seizures such as convulsions, EEG is critical in diagnosis, but there is uncertainty about which EEG patterns represent seizures and which clinical situations and EEG patterns warrant aggressive treatment. Antiseizure medications are tailored to the NCSE type and the clinical condition. Treatment is often easier for NCSE, and the outcome better, than for convulsive SE, but this is not always true for critically ill patients with NCSE in the ICU, for whom continuous EEG monitoring is often crucial for diagnosis and management.

Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus

Neurology ◽  
2001 ◽  
Vol 57 (6) ◽  
pp. 1036-1042 ◽  
Author(s):  
J. Claassen ◽  
L. J. Hirsch ◽  
R. G. Emerson ◽  
J. E. Bates ◽  
T. B. Thompson ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Nonconvulsive Status Epilepticus ◽  
Eeg Monitoring ◽  
Midazolam Infusion ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

Early Epileptiform Discharges and Clinical Signs Predict Nonconvulsive Status Epilepticus on Continuous EEG

2018 ◽  
Vol 29 (3) ◽  
pp. 388-395 ◽  
Author(s):  
Johannes Koren ◽  
Johannes Herta ◽  
Simone Draschtak ◽  
Georg Pötzl ◽  
Franz Fürbass ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Clinical Signs ◽  
Nonconvulsive Status Epilepticus ◽  
Epileptiform Discharges ◽  
Continuous Eeg

Nonconvulsive Status Epilepticus on Electroencephalography in a Case With Subacute Sclerosing Panencephalitis

2006 ◽  
Vol 21 (3) ◽  
pp. 256-260
Author(s):  
Ömer Faruk Aydin ◽  
Nesrin Şenbil ◽  
Y. K. Yavuz Gürer
Keyword(s):  
Status Epilepticus ◽  
Subacute Sclerosing Panencephalitis ◽  
Closed Head Injury ◽  
High Amplitude ◽  
Nonconvulsive Status Epilepticus ◽  
Computed Tomographic ◽  
Cognitive Difficulties ◽  
Intravenous Diazepam ◽  
Electroencephalogram Eeg ◽  
The Brain

Subacute sclerosing panencephalitis is a neurodegenerative disease with a poor prognosis. We report a case of a 5Z\x-year-old boy who had emotional lability, cognitive difficulties, and myoclonia after a mild closed head injury. The magnetic resonance image of the brain and computed tomographic scan of the head were normal. His electroencephalogram (EEG) showed continuous nonconvulsive status epilepticus activity, which could not be suppressed with intravenous diazepam. After treatment with phenytoin for 2 days, an EEG showed periodic high-amplitude sharp-and-slow-wave complexes, which were also not suppressed with intravenous diazepam. Since the patient had measles at 5 months of age, subacute sclerosing panencephalitis was considered, and the diagnosis was confirmed by the presence of measles antibodies in cerebrospinal fluid. ( J Child Neurol 2006;21:256—260; DOI 10.2310/7010.2006.00056).

scholarly journals Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring

1999 ◽  
Vol 91 (5) ◽  
pp. 750-760 ◽  
Author(s):  
Paul M. Vespa ◽  
Marc R. Nuwer ◽  
Valeriy Nenov ◽  
Elisabeth Ronne-Engstrom ◽  
David A. Hovda ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Status Epilepticus ◽  
Brain Injury ◽  
Scale Score ◽  
Eeg Monitoring ◽  
Content Type ◽  
Continuous Eeg ◽  
Nonconvulsive Seizures ◽  
Continuous Eeg Monitoring ◽  
Fine Print

Object. The early pathophysiological features of traumatic brain injury observed in the intensive care unit (ICU) have been described in terms of altered cerebral blood flow, altered brain metabolism, and neurochemical excitotoxicity. Seizures occur in animal models of brain injury and in human brain injury. Previous studies of posttraumatic seizures in humans have been based principally on clinical observations without a systematic approach to electroencephalographic (EEG) recording of seizures. The purpose of this study was to determine prospectively the incidence of convulsive and nonconvulsive seizures by using continuous EEG monitoring in patients in the ICU during the initial 14 days postinjury.Methods. Ninety-four patients with moderate-to-severe brain injuries underwent continuous EEG monitoring beginning at admission to the ICU (mean delay 9.6 ± 5.4 hours) and extending up to 14 days postinjury. Convulsive and nonconvulsive seizures occurred in 21 (22%) of the 94 patients, with six of them displaying status epilepticus. In more than half of the patients (52%) the seizures were nonconvulsive and were diagnosed on the basis of EEG studies alone. All six patients with status epilepticus died, compared with a mortality rate of 24% (18 of 73) in the nonseizure group (p < 0.001). The patients with status epilepticus had a shorter mean length of stay (9.14 ± 5.9 days compared with 14 ± 9 days [t-test, p < 0.03]). Seizures occurred despite initiation of prophylactic phenytoin on admission to the emergency room, with maintenance at mean levels of 16.6 ± 2.8 mg/dl. No differences in key prognostic factors (such as the Glasgow Coma Scale score, early hypoxemia, early hypotension, or 1-month Glasgow Outcome Scale score) were found between the patients with seizures and those without.Conclusions. Seizures occur in more than one in five patients during the 1st week after moderate-to-severe brain injury and may play a role in the pathobiological conditions associated with brain injury.

Nonconvulsive Status Epilepticus in Metabolic Encephalopathy in Indonesia Referral Hospital

2021 ◽  
Vol 69 (2) ◽  
pp. 354 ◽  
Author(s):  
Fitri Octaviana ◽  
AndrianiP Bestari ◽  
AnastasiaM Loho ◽  
LuhA Indrawati ◽  
Winnugroho Wiratman ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Referral Hospital ◽  
Nonconvulsive Status Epilepticus ◽  
Metabolic Encephalopathy
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