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Periodic discharges with triphasic morphology: a differential diagnosis and therapeutic approaches

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The article presents two clinical cases of intensive care unit (ICU) patients with periodic discharges. Examination according to the American Clinical Neurophysiology Society (ACNS) protocol with the use of electroencephalography and functional probes allows differential diagnosis of periodic discharges, which makes it possible to conduct early pathophysiological treatment, to assess its effectiveness in dynamics and to avoid unjustified prescription of antiepileptic drugs. At the same time, the prognosis of the disease and the effectiveness of treatment are largely determined by the etiology of the disease. Evaluation of periodic discharges of three-phase morphology in ICU, considering its nosological nonspecificity, is rational to carry out according to the ACNS recommendations, indicating the ictal genesis, background activity, response to antiepileptic drugs.

About the Authors

D. S. Kan’shina
Pirogov National Medical and Surgical Center; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma
Russian Federation

Darya S. Kan’shina – MD, PhD, Associate Professor, Chair of Neurology with Neurosurgery Course, Pirogov National Medical and Surgical Center; Head of Department of Neurology and Clinical Neurophysiology, Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

RSCI SPIN-code: 4032-4210

70 Nizhnyaya Pervomayskaya Str., Moscow 105203

22 Bolshaya Polyanka Str., Moscow 119180

I. V. Okuneva
Veltishchev Research Clinical Institute of Pediatrics, Pirogov Russian National Research Medical University
Russian Federation

Irina V. Okuneva – Neurologist, Video-EEG Monitoring Cabinet, Psychoneurological Department No. 1

2 Taldomskaya, Moscow 125412

A. V. Vakhlyaev
Pirogov National Medical and Surgical Center
Russian Federation

Anton V. Vakhlyaev – Anesthesiologist-Resuscitator, Department of Anesthesiology and Resuscitation

RSCI SPIN-code: 4180-0780

70 Nizhnyaya Pervomayskaya Str., Moscow 105203

O. Yu. Bronov
Pirogov National Medical and Surgical Center
Russian Federation

Oleg Yu. Bronov – MD, PhD, Head of Department of Radiology, Associate Professor, Chair of Radiation Diagnostics with a Course of Clinical Radiology

Scopus Author ID: 57215892759; RSCI SPIN-code: 7429-7993

70 Nizhnyaya Pervomayskaya Str., Moscow 105203


1. Hirsch L.J., LaRoche S.M., Gaspard N., et al. American Clinical Neurophysiology Society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013; 30 (1): 1–27.

2. van Putten M.J., Hofemeier J. Generalized periodic discharges: pathophysiology and clinical considerations. Epilepsy Behav. 2015; 49: 228–33.

3. Karnaze D.S., Bickford R.G. Triphasic waves: a reassessment of their significance. Electroencephalogr Clin Neurophysiol. 1984; 57 (3): 193–8.

4. Mazurenko E.V., Solovey N.V., Danilkovich L.S. Creutzfeldt–Jakob disease: the role of modern methods of examination in the life-time diagnosis of the disease. Meditsinskie novosti / Medical News. 2019; 4: 35-41 (in Russ.).

5. LoLo Giudice P., Ursino D., Mammone N., et al. A network analysis based approach to characterizing periodic sharp wave complexes in electroencephalograms of patients with sporadic CJD. Int J Med Inform. 2019; 121: 19–29.

6. Sully K.E., Husain A.M. Generalised periodic discharges: a topical review. J Clin Neurophysiol. 2018; 35 (3): 199–207.

7. Foreman B., Mahulicar A., Tadi P., et al. Generalised periodic discharges and `triphasic waves`: a blinded evaluation of inter-rater agreement and clinical cignificance. Clin Neurophysiol. 2016; 127 (2): 1073–80.

8. Rodrigues Ruiz A., Vlachy J., Lee J.W., et al. Association of periodic and rhythmic electroencephalographic patterns with seizures in critical ill patients. JAMA Neurol. 2017; 74 (2): 181–8.

9. Baranova E.A., Danilova T.V., Khalitov I.R., Sinkin M.V. Nonconvulsive status epilepticus with triphasic waves on EEG. Annals of Clinical and Experimental Neurology. 2020; 14 (1): 97–103 (in Russ.).

10. Kane N., Acharya J., Beniczky S., et al. A revised glossary of terms most commonly used by clinical electroencephalographers and updated proposal for the report format of the EEG findings. Revision 2017. Clin Neurophysiol Prac. 2017; 2: 170–85.

11. Leitinger M., Beniczky S., Rohracher A., et al. Salzburg consensus crite-ria for non-convulsive status epilepticus – approach to clinical application. Epilepsy Behav. 2015; 49: 158–63.

12. O’Rourke D., Chen P.M., Gaspard N., et al. Response rates to anticonvul-sant trials in patients with triphasic-wave EEG patterns of uncertain significance. Neurocrit Care. 2016; 24 (2): 233–9.

13. Trinka E., Leitinger M. Which EEG patterns in coma are nonconvulsive status epilepticus? Epilepsy Behav. 2015; 49: 203–22.

14. Herman S.T., Abend N.S., Bleck T.P., et al. Consensus statement on continuous EEG in critically ill adults and children, part 1: indications. J Clin Neurophysiol. 2015; 32 (2): 87–95.

15. Bickford R.G., Butt H.R. Hepatic coma: the electroencephalographic pattern. J Clin Invest. 1955; 34 (6): 790–9.

16. Foley J.M., Watson C.W., Adams R.D. Significance of the electroencephalographic changes in hepatic coma. Trans Am Neurol Assoc. 1950; 51: 161–5.


For citations:

Kan’shina D.S., Okuneva I.V., Vakhlyaev A.V., Bronov O.Yu. Periodic discharges with triphasic morphology: a differential diagnosis and therapeutic approaches. Epilepsy and paroxysmal conditions. 2021;13(2):124-131. (In Russ.)

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ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)