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Triphasic waves: clinical correlates and morphology.

M B Sundaram, W T Blume

    The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
    |May 1, 1987
    PubMed
    Summary
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    Triphasic waves in electroencephalograms (EEGs) are not specific to metabolic encephalopathies but are linked to patient consciousness level. Prognosis for both metabolic and non-metabolic encephalopathies remains poor.

    Area of Science:

    • Clinical Neurophysiology
    • Neurology
    • Critical Care Medicine

    Background:

    • Triphasic waves are EEG patterns observed in encephalopathies.
    • Their specificity and association with metabolic versus non-metabolic causes require clarification.
    • Understanding their link to clinical status and prognosis is crucial for patient management.

    Purpose of the Study:

    • To investigate the diagnostic specificity of triphasic waves for metabolic encephalopathies.
    • To correlate EEG features of triphasic waves with etiology and clinical presentation.
    • To assess the prognostic value of triphasic waves in encephalopathic patients.

    Main Methods:

    • Retrospective analysis of 63 consecutive patients with triphasic waves.
    • Categorization into metabolic and non-metabolic encephalopathies.

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  • Correlation of EEG morphology, distribution, and patient's conscious level (alert vs. comatose) with etiology and prognosis.

    • Main Results:

    • 41% of patients had metabolic encephalopathies; 59% had non-metabolic (e.g., senile dementia).
    • Triphasic waves were not specific to any metabolic encephalopathy type.
    • Consciousness level strongly correlated with etiology: alert patients had non-metabolic, comatose patients had metabolic encephalopathies.
    • Posterior-anterior lag of Wave II peak was more common in metabolic encephalopathies.
    • Prognosis was poor for both groups, with low recovery rates at 2-year follow-up.
    • Sporadic triphasic waves were noted in 40% of EEGs with slow spike waves.

    Conclusions:

    • Triphasic waves are not specific for metabolic encephalopathies but are strongly associated with the patient's level of consciousness.
    • Clinical status (alertness vs. coma) is a better indicator of etiology than EEG morphology alone.
    • The presence of triphasic waves indicates a poor prognosis regardless of the underlying cause.