Brandon Foreman1, Advait Mahulikar2, Prasanna Tadi2, Jan Claassen2, Jerzy Szaflarski3, Jonathan J Halford4, Brian C Dean5, Peter W Kaplan6, Lawrence J Hirsch7, Suzette LaRoche8. 1. Columbia University Medical Center, Division of Critical Care Neurology, 177 Fort Washington Ave, Milstein 8 Center Room, New York, NY 10032, USA. Electronic address: brandon.foreman@uc.edu. 2. Columbia University Medical Center, Division of Critical Care Neurology, 177 Fort Washington Ave, Milstein 8 Center Room, New York, NY 10032, USA. 3. University of Alabama at Birmingham, Department of Neurology, 1719 6th Avenue South, CIRC 312, Birmingham, AL 35294, USA. 4. Medical University of South Carolina, Department of Neurology, 96 Jonathan Lucas St. CSB 301, Charleston, SC 29425, USA. 5. Clemson University, School of Computing, 100 McAdams Hall, Clemson, SC 29634, USA. 6. Johns Hopkins Bayview Medical Center, Department of Neurology, 301 Mason Lord Drive, Ste 2100, Baltimore, MD 21224, USA. 7. Yale University, Department of Neurology, 15 York Street, LCI 300, New Haven, CT 06520, USA. 8. Emory University School of Medicine, Department of Neurology, 1365 Clifton Rd, Atlanta, GA 30322, USA.
Abstract
OBJECTIVES: Generalized periodic discharges (GPDs) are associated with nonconvulsive seizures. Triphasic waves (TWs), a subtype of GPDs, have been described in relation to metabolic encephalopathy and not felt to be associated with seizures. We sought to establish the consistency of use of this descriptive term and its association with seizures. METHODS: 11 experts in continuous EEG monitoring scored 20 cEEG samples containing GPDs using Standardized Critical Care EEG Terminology. In the absence of patient information, the inter-rater agreement (IRA) for EEG descriptors including TWs was assessed along with raters' clinical EEG interpretation and compared with actual patient information. RESULTS: The IRA for 'generalized' and 'periodic' was near-perfect (kappa=0.81), but fair for 'triphasic' (kappa=0.33). Patients with TWs were as likely to develop seizures as those without (25% vs 26%, N.S.) and surprisingly, patients with TWs were less likely to have toxic-metabolic encephalopathy than those without TWs (55% vs 79%, p<0.01). CONCLUSIONS: While IRA for the terms "generalized" and "periodic" is high, it is only fair for TWs. EEG interpreted as TWs presents similar risk for seizures as GPDs without triphasic appearance. GPDs are commonly associated with metabolic encephalopathy, but 'triphasic' appearance is not predictive. SIGNIFICANCE: Conventional association of 'triphasic waves' with specific clinical conditions may lead to inaccurate EEG interpretation.
OBJECTIVES: Generalized periodic discharges (GPDs) are associated with nonconvulsive seizures. Triphasic waves (TWs), a subtype of GPDs, have been described in relation to metabolic encephalopathy and not felt to be associated with seizures. We sought to establish the consistency of use of this descriptive term and its association with seizures. METHODS: 11 experts in continuous EEG monitoring scored 20 cEEG samples containing GPDs using Standardized Critical Care EEG Terminology. In the absence of patient information, the inter-rater agreement (IRA) for EEG descriptors including TWs was assessed along with raters' clinical EEG interpretation and compared with actual patient information. RESULTS: The IRA for 'generalized' and 'periodic' was near-perfect (kappa=0.81), but fair for 'triphasic' (kappa=0.33). Patients with TWs were as likely to develop seizures as those without (25% vs 26%, N.S.) and surprisingly, patients with TWs were less likely to have toxic-metabolic encephalopathy than those without TWs (55% vs 79%, p<0.01). CONCLUSIONS: While IRA for the terms "generalized" and "periodic" is high, it is only fair for TWs. EEG interpreted as TWs presents similar risk for seizures as GPDs without triphasic appearance. GPDs are commonly associated with metabolic encephalopathy, but 'triphasic' appearance is not predictive. SIGNIFICANCE: Conventional association of 'triphasic waves' with specific clinical conditions may lead to inaccurate EEG interpretation.
Authors: Tadeu A Fantaneanu; Rani Sarkis; Kathleen Avery; Benjamin M Scirica; Shelley Hurwitz; Galen V Henderson; Jong Woo Lee Journal: Neurocrit Care Date: 2017-06 Impact factor: 3.210
Authors: Ayham Alkhachroum; Brian Appavu; Benjamin Rohaut; Jan Claassen; Satoshi Egawa; Brandon Foreman; Nicolas Gaspard; Emily J Gilmore; Lawrence J Hirsch; Pedro Kurtz; Virginie Lambrecq; Julie Kromm; Paul Vespa; Sahar F Zafar Journal: Intensive Care Med Date: 2022-08-23 Impact factor: 41.787
Authors: K G van Leeuwen; H Sun; M Tabaeizadeh; A F Struck; M J A M van Putten; M B Westover Journal: Clin Neurophysiol Date: 2018-11-17 Impact factor: 3.708