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Status Triphasicus Versus Status Epilepticus?

Manuel M Bicchi1,2, Ayham Alkhachroum1,2, Andres M Kanner1,2

  • 1Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.; and.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|June 22, 2021
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Summary

Triphasic waves (TWs), now termed status triphasicus, are distinct electrographic patterns. Differentiating them from ictal discharges is crucial for managing comatose patients with nonconvulsive status epilepticus.

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Area of Science:

  • Neurophysiology
  • Clinical Neurology
  • Electroencephalography (EEG)

Background:

  • Triphasic waves (TWs) are generalized periodic patterns historically linked to metabolic encephalopathies.
  • Recent classifications group TWs with generalized periodic discharges (GPDs), often associated with ictal activity.
  • Distinguishing nonictal TWs from ictal GPDs is critical for managing comatose patients, particularly in nonconvulsive status epilepticus.

Purpose of the Study:

  • To define and characterize a distinct electrographic pattern termed "status triphasicus."
  • To differentiate status triphasicus from periodic ictal generalized periodic discharge patterns.
  • To propose a pragmatic classification for status triphasicus encompassing various clinical scenarios.

Main Methods:

  • Analysis of electrographic characteristics differentiating nonictal TWs from ictal GPDs.
  • Identification of three key features: specific discharge morphology and distribution, response to spontaneous/pharmacological interventions, and reactivity to stimulation.
  • Review of literature and clinical scenarios associating status triphasicus with ictal activity.

Main Results:

  • Status triphasicus is characterized by specific TW morphology, location, and patterns of change.
  • Key distinguishing features include spontaneous/benzodiazepine-induced attenuation and stimulation-induced activation.
  • These characteristics help differentiate nonictal status triphasicus from ictal GPDs.

Conclusions:

  • Status triphasicus represents a distinct electrographic entity separate from periodic ictal generalized periodic discharge patterns.
  • Understanding these distinctions is vital for accurate diagnosis and management of critically ill patients.
  • A pragmatic classification aids in encompassing diverse clinical presentations associated with status triphasicus.