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Focal triphasic sharp waves and spikes in the electroencephalogram.

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Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Focal triphasic sharp waves and spikes (FTSW) are rare EEG events, primarily seen in epilepsy patients under 20. These discharges suggest underlying chronic central nervous system (CNS) pathology, warranting neuroimaging.

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Area of Science:

  • Neurology
  • Neurophysiology
  • Epileptology

Background:

  • Interictal epileptiform discharges (IEDs) are crucial in epilepsy diagnosis.
  • The negative (fast) phase of IEDs is well-studied, but the after-coming slow wave (ASW) significance is often overlooked.
  • Prominent ASW can create a triphasic morphology in IEDs, termed focal triphasic sharp waves and spikes (FTSW).

Purpose of the Study:

  • To investigate the clinical, neurophysiological, and neuropathological significance of prominent ASW in IEDs, specifically FTSW.
  • To explore the association between FTSW and underlying central nervous system (CNS) pathologies.
  • To evaluate the diagnostic and therapeutic implications of FTSW detection.

Main Methods:

  • Retrospective analysis of EEG data from a heterogeneous patient group at KKH, Ha'il, KSA.
  • Identification and characterization of FTSW patterns in patient EEGs.
  • Correlation of FTSW findings with clinical epilepsy characteristics, patient demographics, and neuroimaging results.

Main Results:

  • FTSW were identified as rare EEG events, predominantly occurring in patients within their first two decades of life.
  • Ninety percent of patients with FTSW had epilepsy, often presenting with generalized convulsive seizures.
  • Half of the patients with FTSW exhibited chronic/static CNS pathology, notably congenital CNS anomalies. Most patients responded well to anticonvulsant monotherapy.

Conclusions:

  • Prominent ASW, forming FTSW, are significant EEG markers associated with epilepsy and chronic CNS pathologies, especially congenital anomalies.
  • The presence of FTSW necessitates neuroimaging to identify potential underlying structural brain abnormalities.
  • FTSW may indicate a need for aggressive anticonvulsant therapy due to potential links with interictal intellectual dysfunction.