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Source Imaging of Triphasic Waves and Other Encephalopathies.

Muhammad S Zafar1, Shareena A Rahman2, Joshua Andrew Ehrenberg3

  • 1Department of Pediatrics, Duke University Hospital, Durham, North Carolina, U.S.A.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|December 4, 2020
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Summary

Triphasic waves (TWs), a distinct EEG pattern in medically ill patients, originate from anterior midline structures with anterior to posterior propagation. This study used source localization to identify their unique electrographic signature.

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Area of Science:

  • Neuroscience
  • Clinical Electrophysiology

Background:

  • Triphasic waves (TWs) are high-amplitude EEG waveforms observed in medically ill patients.
  • TWs present similarly to other encephalopathies but have unique electrographic features.

Purpose of the Study:

  • To identify a reproducible and unique electrographic signature for TWs.
  • To differentiate TWs from other EEG patterns like Delta and Frontal Intermittent Rhythmic Delta Activity (FIRDA) using source localization.

Main Methods:

  • Retrospective analysis of EEG data from Johns Hopkins and Duke University Hospitals.
  • Source localization performed using Commercial Curry 8 and open-source Brainstorm software.
  • Boundary Element Method head model derived from MNI imaging data; dipole and current density analyses conducted.

Main Results:

  • TWs showed activation of anterior frontal and midline structures.
  • FIRDA exhibited similar localization but lacked a moving dipole.
  • Delta and Theta-Delta patterns originated from more diffuse brain regions.

Conclusions:

  • Source analysis suggests TWs originate in the anterior midline with anterior to posterior propagation.
  • Findings support previous hypotheses regarding TWs' origin.
  • Limitations include retrospective analysis, limited electrodes, and slow-wave analysis challenges, warranting further research.