Generalized periodic discharges and 'triphasic waves': A blinded evaluation of inter-rater agreement and clinical significance
Generalized periodic discharges and 'triphasic waves': A blinded evaluation of inter-rater agreement and clinical significance
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DOI：
10.1016/j.clinph.2015.07.018
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发表时间：
2016-02-01
影响因子：
4.7
通讯作者：
LaRoche, Suzette
中科院分区：
文献类型：
--
作者：
Foreman, Brandon;Mahulikar, Advait;LaRoche, Suzette
目的：全身周期性放电（GPD）与非惊厥性癫痫发作相关。三相波 (TW) 是 GPD 的一种亚型，已被描述与代谢性脑病有关，但不认为与癫痫发作有关。我们试图确定该描述性术语的使用一致性及其与癫痫发作的关联。方法：11 名连续脑电图监测专家使用标准化重症监护脑电图术语对 20 个包含 GPD 的 cEEG 样本进行评分。在缺乏患者信息的情况下，包括 TW 在内的脑电图描述符的评估者间一致性 (IRA) 与评估者的临床脑电图解释一起进行评估，并与实际患者信息进行比较。结果：“全身”和“周期性”的 IRA 近乎完美（kappa = 0.81），但“三相”的 IRA 相当不错（kappa = 0.33）。患有 TW 的患者与没有 TW 的患者一样容易发生癫痫发作（25% vs 26%，NS），令人惊讶的是，与没有 TW 的患者相比，患有 TW 的患者患中毒性代谢性脑病的可能性更小（55% vs 79%，p < 0.01）。结论：虽然“全身性”和“周期性”术语的 IRA 很高，但对 TW 来说是公平的。脑电图解释为 TW 的癫痫发作风险与没有三相表现的 GPD 相似。 GPD 通常与代谢性脑病相关，但“三相”的出现并不能预测。意义：“三相波”与特定临床状况的传统关联可能会导致脑电图解释不准确。 (C) 2015 年国际临床神经生理学联合会。由爱思唯尔爱尔兰有限公司出版。保留所有权利。
Objectives: Generalized periodic discharges (GPDs) are associated with nonconvulsive seizures. Triphasic waves (TWs), a subtype of GPDs, have been described in relation to metabolic encephalopathy and not felt to be associated with seizures. We sought to establish the consistency of use of this descriptive term and its association with seizures.Methods: 11 experts in continuous EEG monitoring scored 20 cEEG samples containing GPDs using Standardized Critical Care EEG Terminology. In the absence of patient information, the inter-rater agreement (IRA) for EEG descriptors including TWs was assessed along with raters' clinical EEG interpretation and compared with actual patient information.Results: The IRA for 'generalized' and 'periodic' was near-perfect (kappa = 0.81), but fair for 'triphasic' (kappa = 0.33). Patients with TWs were as likely to develop seizures as those without (25% vs 26%, N. S.) and surprisingly, patients with TWs were less likely to have toxic-metabolic encephalopathy than those without TWs (55% vs 79%, p < 0.01).Conclusions: While IRA for the terms 'generalized" and 'periodic" is high, it is only fair for TWs. EEG interpreted as TWs presents similar risk for seizures as GPDs without triphasic appearance. GPDs are commonly associated with metabolic encephalopathy, but 'triphasic' appearance is not predictive.Significance: Conventional association of 'triphasic waves' with specific clinical conditions may lead to inaccurate EEG interpretation. (C) 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.