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Atypical triphasic waves associated with the use of pentobarbital
M E Lancman1, S Marks, K Mahmood
1Department of Neurology, Westchester County Medical Center, New York Medical College, Valhalla 10595, USA.
Electroencephalography and Clinical Neurophysiology
|March 1, 1997
Summary
Triphasic waves, a rare EEG pattern, were observed in a patient undergoing pentobarbital treatment for a neurological condition. This finding is important for clinicians to recognize and avoid misinterpreting as electrical status epilepticus.
Area of Science:
- Neurology
- Clinical Neurophysiology
Background:
- Pentobarbital coma is used for refractory status epilepticus and to reduce brain metabolism in certain neurological conditions.
- High-dose pentobarbital typically induces burst-suppression on EEG, while lower doses cause diffuse slowing.
- Triphasic waves have not been previously associated with pentobarbital therapy.
Observation:
- A 54-year-old female developed generalized triphasic waves with anterior predominance on EEG during pentobarbital treatment for a carotid artery injury post-aneurysm surgery.
- The patient was initially comatose with a burst-suppression pattern on EEG and a pentobarbital level of 30.5 µg/dL.
- A week later, despite a reduced pentobarbital level of 11 µg/dL, the EEG displayed triphasic waves, and the patient remained comatose.
Findings:
- The emergence of triphasic waves during pentobarbital therapy is a novel observation.
- The patient's EEG normalized, and she recovered fully after pentobarbital was discontinued.
- Triphasic waves can occur in patients receiving pentobarbital, even at lower therapeutic levels.
Implications:
- Clinicians should be aware that triphasic waves can manifest in patients treated with pentobarbital.
- This EEG pattern should not be mistaken for 'electrical' status epilepticus, which requires different management.
- Recognizing this association aids in accurate diagnosis and appropriate patient care during pentobarbital therapy.