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Uncovering clinical and radiological associations of triphasic waves in acute encephalopathy: a case–control study
Author(s) -
Sutter R.,
Kaplan P. W.
Publication year - 2014
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12372
Subject(s) - medicine , odds ratio , glasgow coma scale , atrophy , confidence interval , encephalopathy , neuroimaging , gastroenterology , surgery , psychiatry
Background and purpose Triphasic waves ( TW s) are archetypal waveforms seen on electroencephalography ( EEG ) in some forms of encephalopathy. Their particular underlying pathological substrates are largely unexplored. This case–control study was designed to identify and quantify specific clinical and neuroradiological associations underlying TW s and to determine if TW s predicate outcome. Methods From 2004 to 2012, adult encephalopathic patients with TW s (cases) were matched 1:1 with encephalopathic patients without TW s (controls) by Glasgow Coma Scale (GCS) and the frequency range of EEG background activity. Clinical characteristics, neuroimaging and outcomes were assessed. Results The mean age of 190 patients (95 with and 95 without TW s) was 66.6 years (±15.6). In multivariable analyses, patients with TW s had significantly higher odds for liver insufficiency [odds ratio ( OR ) = 8.10, 95% confidence interval ( CI ) 1.98–33.08], alcohol abuse ( OR = 3.65, 95% CI 1.25–10.63), subcortical brain atrophy ( OR = 2.82, 95% CI 1.39–5.71) and respiratory tract infections ( OR = 1.28, 95% CI 1.01–4.71). With each additional independent predictor, the odds increased for the occurrence of TW s (1 predictor, OR = 2.40, 95% CI 1.16–5.13; ≥2 predictors, OR = 9.20, 95% CI 3.27–25.62). Mortality was 15% and tended to be higher in patients with TW s (19% with vs. 11% without TW s). Conclusions Alcohol abuse, liver insufficiency, infections and subcortical brain atrophy were independently associated with TW s in patients matched for clinical and EEG features of encephalopathy. These associations strengthen the hypothesis that TW s evolve from an interplay of pathological neurostructural, metabolic and toxic conditions. When matched for EEG background activity and GCS , TW s were not associated with death.