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Atypical or Typical Triphasic Waves-Is There a Difference? A Review.

José L Fernández-Torre1,2, Peter W Kaplan3

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Triphasic waves (TWs) on EEG are often subjective. Typical TWs suggest toxic-metabolic encephalopathies, while atypical forms indicate diverse neurological conditions.

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Area of Science:

  • Neurophysiology
  • Electroencephalography (EEG)
  • Neurology

Background:

  • Triphasic waves (TWs) on EEG lack standardized interpretation guidelines.
  • Distinguishing typical from atypical TWs is crucial for diagnosing encephalopathies.

Purpose of the Study:

  • To clarify the diagnostic characteristics of typical and atypical triphasic waves.
  • To differentiate TWs associated with toxic-metabolic encephalopathies from other neurological disorders.

Main Methods:

  • Review and analysis of EEG findings related to triphasic waves.
  • Comparison of TW morphologies and their associated clinical etiologies.

Main Results:

  • Typical TWs are bilateral, synchronous, fronto-central, 1.5-2.0 Hz complexes, highly suggestive of hepatic, uremic, or sepsis-associated encephalopathies.
  • Atypical TWs present with varied morphologies and are associated with conditions like Angelman syndrome, toxic encephalopathies, and nonconvulsive status epilepticus.

Conclusions:

  • The interpretation of TWs requires careful consideration of morphology, reactivity, and clinical context.
  • Atypical TWs may indicate a broader range of neurological conditions beyond toxic-metabolic encephalopathies.
  • Further research is needed to establish a clear clinical dichotomy for TW interpretation.