Triphasic waves and brain atrophy in patients with acute encephalopathy / Ondas trifásicas y atrofia cerebral en pacientes con encefalopatía aguda

Abstract Introduction: Triphasic waves (TW) constitute an electroencephalographic pattern associated with certain kinds of encephalopathy. Brain atrophy may be a predisposing factor linked with TW. Objective: To compare the degree of brain atrophy and white matter disease between patients with acute encephalopathy with and without TW. Methods: A retrospective observational study including adult patients with encephalopathy, with and without TW, hospitalized between 2016 and 2017. The degree of brain atrophy and white matter lesion were defined using the Global Cortical Atrophy and Age Related White Matter Changes (ARWMC) scales, respectively. Scores were compared between groups. Mortality rates were registered. Results: Sixteen patients with TW were identified matched by age and sex with 30 patients without TW. The mean age was 80 years in the TW group. Women represented 87.5%. Multifactorial encephalopathy was the most frequent diagnosis followed by metabolic encephalopathy. Patients with TW had more brain atrophy (10.43 vs 6.9, p= 0.03). Mean ARWMC was 9.43±6.5 and 8.5 ±7.89 in patients with and without TW respectively (p= 0.5). Mortality rate was higher in the TW group (31.25 vs 6.66% p= 0.02). Conclusions: Patients with acute encephalopathy and TW had higher degree of cerebral atrophy. It is possible that this structural alteration predisposes to the appearance of TW. There was no significant difference in white matter lesion degree. The mortality of the TW group was high, so future studies are necessary to determine their prognostic value.

Resumen Introducción: Las ondas trifásicas (OT) constituyen un patrón electroencefalográfico asociado con diversas encefalopatías. La atrofia cerebral podría predisponer a su aparición. Objetivo: Comparar el grado de atrofia cerebral y de lesión de sustancia blanca en pacientes con encefalopatía aguda con y sin OT. Métodos: Estudio observacional retrospectivo, incluyó pacientes adultos con encefalopatía aguda con y sin OT internados entre 2016 y 2019. El grado de atrofia cerebral y de lesión de sustancia blanca se definieron según las escalas Global Cortical Atrophy y Age Related White Matter Changes (ARWMC), respectivamente. Se compararon los puntajes entre grupos. Se registró la mortalidad. Resultados: Se identificaron 16 pacientes con OT y 30 sin OT pareados según edad y sexo. La edad promedio del grupo con OT fue 80 años. El 87.5% fueron mujeres. La encefalopatía multifactorial fue el diagnóstico más frecuente seguido de la encefalopatía metabólica. El grado de atrofia fue mayor en pacientes con OT (10.43 vs 6.9, p= 0.03). El puntaje ARWMC fue 9.43 ±6.5 y 8.5 ±7.89 en pacientes con y sin OT respectivamente (p= 0.5). La mortalidad fue mayor en el grupo con OT (31.25 vs 6.66% p= 0.02). Conclusiones: Pacientes con encefalopatía aguda y OT tuvieron mayor grado de atrofia cerebral. Dicha alteración estructural podría relacionarse con la aparición de OT. No hubo diferencias significativas en el grado de lesión de sustancia blanca. La mortalidad del grupo con OT fue elevada. Son necesarios estudios para determinar su valor pronóstico.

Immobilisation of solvatochromic dyes on transparent cellulose films; an improved methodology for the study of homeopathic potencies

Highly diluted and succussed solutions (homeopathic potencies) have been shown to interact with a wide range of solvatochromic dyes based on changes in their UV-visible spectra. Studies so far have involved free dyes in solution, but there is a pressing need to find ways to investigate the potency-dye interaction using isolated dye molecules in order to ask more searching physico-chemical questions regarding the fundamental nature of potencies. Aims and Methods:The aims of the present study have been tolook for ways to covalently immobilizesolvatochromic dyes onto transparent cellulose films and hence be in a position to investigate dye-potency interactions without the complication of dye-dye interactions, including dye aggregation, which can occur with free dyes in solution. Results: to date a total of nine different dyes have been immobilised on cellulose films using epoxide activation of hydroxyl groups on the cellulose surface. Using this methodology studies have begun looking at the time course of potency action on one of these immobilised dyes, Brooker's merocyanine. Results show that the interaction ofArsenicum10M with this dye consists of three phases ­an initial growth phase, a sustained plateau of interaction and a final decline phase lasting several days.Conclusions: amethodology has been developed that successfully immobilises solvatochromic dyes onto transparent cellulose film. These films can then be used in a spectrophotometer to study at a much more detailed level how potencies interact with dyes compared with using free dyes in solution. Results indicate that the information gained in this way provides new insights regarding the fundamental nature of potencies. Specifically, studies using immobilised Brooker's merocyanine with Arsenicum10M reveal that the lifetime of the potency is much longer than expected and that its action consists of three distinct phases, suggesting a resonant interaction with the dye.

Generalized periodic discharges with triphasic morphology

Generalized periodic discharges (GPDs) with triphasic morphology are an electroencephalographic (EEG) pattern traditionally associated with encephalopathy and coma, although they have been observed in a wide array of neurological disorders. The clinical significance of these waveforms and their relationship to seizures and prognosis has been debated, and differentiation between interictal patterns, patterns associated with seizures, and patterns representing nonconvulsive status epilepticus can at times be a challenge. The most established literature suggests that GPDs, including those with triphasic morphology, are associated with the development of electrographic seizures, but that in the absence of clinical information, distinguishing waveforms based on morphology alone may not be clinically useful. Recent work has advocated for a more proactive approach in evaluating GPDs with triphasic morphology. Further studies of nonsedating antiseizure drugs in patients with GPDs with triphasic morphology that incorporate continuous EEG monitoring will be useful in tailoring therapy to optimize long-term clinical outcomes and recovery.

Significance of Triphasic Waves in Metabolic Encephalopathy / 대한임상신경생리학회지

BACKGROUND: Triphasic waves are one of the electroencephalographic patterns that can be usually seen in metabolic encephalopathy. The aim of this study is to compare the clinical and electrophysiologic profiles between patients with and without triphasic waves in metabolic encephalopathy, and reassess the significance of triphasic waves in metabolic encephalopathy. METHODS: We recruited 127 patients with metabolic encephalopathy, who were admitted to our hospital. We divided these admitted patients into two groups; those with and without triphasic waves. We analyzed the difference of duration of hospitalization, mortality rate during admission, Glasgow Coma Scale, severity of electroencephalographic alteration, and presence of acute symptomatic seizures between these two groups. RESULTS: Of the 127 patients with metabolic encephalopathy, we excluded 67 patients who did not have EEG, and 60 patients finally met the inclusion criteria for this study. Patients with triphasic waves had more severe electroencephalographic alterations, lower Glasgow Coma Scale, and more acute symptomatic seizures than those without triphasic waves. After adjusting the clinical variables, Glasgow Coma Scale and acute symptomatic seizures were only significantly different between patients with and without triphasic waves. CONCLUSIONS: We demonstrated that patients with triphasic waves in metabolic encephalopathy had more significant impairment of the brain function.

Cisplatin-Induced Encephalopathy With Status Epilepticus

A 75-year old man with esophageal cancer presented with mental status change and seizures. He was under cisplatinand developed several times of generalized tonic-clonic seizures. The EEG (electroencephalography) showed triphasic waves and slowed background activity. He was diagnosed with status epilepticus and encephalopathy caused by cisplatin. He was treated with anticonvulsants and cisplatin was replaced by docetaxel. His mentality recovered completely and he had no more seizure. We conclude that physician using cisplatin should be aware of this rare complication.

Periodic EEG patterns: importance of their recognition and clinical significance / Padrões eletrencefalográficos periódicos: importância do seu reconhecimento e significado clínico

Periodic electroencephalographic (EEG) patterns consist of discharges usually epileptiform in appearance, which occur at regular intervals, in critical patients. They are commonly classified as periodic lateralized epileptiform discharges (PLEDs), bilateral independent PLEDs or BIPLEDs, generalized epileptiform discharges (GPEDs) and triphasic waves. Stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) are peculiar EEG patterns, which may be present as periodic discharges. The aim of this study is to make a review of the periodic EEG patterns, emphasizing the importance of their recognition and clinical significance. The clinical significance of the periodic EEG patterns is uncertain, it is related to a variety of etiologies, and many authors suggest that these patterns are unequivocally epileptogenic in some cases. Their recognition and classification are important to establish an accurate correlation between clinical, neurological, laboratorial and neuroimaging data with the EEG results.

Padrões eletrencefalográficos (EEG) periódicos consistem em descargas geralmente epileptiformes em aparência, que ocorrem a intervalos regulares, em pacientes críticos. Esses padrões são habitualmente classificados como descargas epileptiformes periódicas lateralizadas (PLEDs), PLEDs bilaterais e independentes ou BIPLEDs, descargas epileptiformes periódicas generalizadas (GPEDs) e ondas trifásicas. Descargas rítmicas, periódicas ou ictais induzidas por estímulos (SIRPIDs) são padrões eletrencefalográficos peculiares, que podem se apresentar como descargas periódicas. O objetivo deste estudo é fazer uma revisão dos padrões EEG periódicos, enfatizando a importância do seu reconhecimento e seu significado clínico. O significado clínico dos padrões EEG periódicos é incerto. Está relacionado a uma variedade de etiologias e muitos autores sugerem que tais padrões sejam inequivocamente de natureza epileptogênica em alguns casos. O seu reconhecimento e classificação são importantes para estabelecer uma correlação acurada entre dados clínicos, neurológicos, laboratoriais e de neuroimagem com os resultados de EEG.

Triphasic mechanical properties of osteoarthritis cartilage with different pathological grades / 医用生物力学

Objective To obtain the axial elastic modulus of rabbit articular cartilage based on the ultrasound swelling observation technique and the triphasic theory, and to explore the triphasic mechanical properties of the osteoarthritis cartilage with different pathological grades. Methods The articular cartilage samples from rabbit knees were assessed according to the different pathological grades. The swelling strains were recorded based on the high frequency transient ultrasound measurement technique. The axial elastic modulus of the cartilage samples was extracted based on the fixed charge density, the water volume fraction and the triphasic model. Correlation analysis was also made. Results There were both significant differences in axial elastic modulus between the normal cartilages and among the osteoarthritis cartilage with different pathological grades (P<0.05). The value of axial elastic modulus decreased with the increase of osteoarthritis grades. For normal cartilage samples, the average axial elastic modulus was (15.87±6.30) MPa. For osteoarthritis cartilages of grade 1, 2 and 3, the value of axial elastic modulus were (11.33±5.21), (9.15±5.68) and (6.05±4.99) MPa, respectively. Conclusions This study showed there are significant differences in triphasic mechanical properties of the articular cartilage with different osteoarthritis grades, which may provide some new thought for the quantitative assessment of osteoarthritis grade based on mechanical properties of cartilage.

Cefepime-Induced Reversible Encephalopathy with Triphasic Waves in Patients with Impaired Renal Function / 대한간질학회지

Cefepime is a widely used beta-lactam antibiotic. We first report two cases of cefepime-induced reversible encephalpathy in Korea. Two patients with renal impairment presented stupor while being treated with cefepime for pneumonia, one of whom also developed myoclonus and asterixis. Their electroencephalogram showed triphasic waves despite of normal liver function. After discontinuation of cefepime, they completely recovered with normalization of electroencephalogram. Early recognition of cefepime-induced encephalopathy and immediate withdrawal of cefepime would be important for the prognosis of the patients.

A Case of Valproate-Induced Hyperammonemic Encephalopathy with Triphasic Waves / 대한간질학회지

Valproate is a widely used antiepileptic drug with rarely occurring serious side effects. However, valproate may induce hyperammonemic encephalopathy. A 85-year-old woman was admitted with stuporous mental status. Brain MRI showed old cerebral infarction and EEG showed sharp waves in the right frontal region. Under the impression of postictal confusion, we used phenytoin and then she was improved. However, the intermittent vacant staring was seen, and valproate was administered additionally. On the 5th day after adding valproate, her mentality was deteriorated and intermittent triphasic waves appeared on EEG. Due to confused mentality and hyperactivities, we injected lorazepam and then semicomatous mentality was developed. Follow-up EEG showed nearly continuous triphasic waves and slightly elevated ammonia with normal liver function was shown. After stopping antiepileptic drugs, we used lactulose and flumazenil, and then she was fully recovered with normalized EEG. This is a rare case of valproate-induced hyperammonemic encephalopathy with triphasic waves.

Estimation of Uniaxial Modulus of Articular Cartilage Based on Inhomogeneous 4 Parameters Triphasic Mode / 航天医学与医学工程

Objective To study the material attribute of articular cartilage.Methods An improved 4 parameters inhomogeneous triphasic model based on 3 parameters model was developed to estimate the uniaxial modulus Ha of cartilage and to predict the swelling pattern of cartilage.Results The results showed that more accurate uniaxial modulus can be extracted using 4 parameters inhomogeneous triphasic model,and the predicted results appeared to match the experimental strain data better than other models.Conclusion Inhomogeneous 4 parameters triphasic model can describe the depth-dependent material attribute of articular cartilage more exactly.

Experimental study on progestogen activity of triphasic contraceptive tablets / 中国药理学通报

Aim To study the progestogen effect and activity of triphasic contraceptive tablets.Methods The progestogen activity of triphasic contraceptive tablets (kalirui and trinordiol) was evaluated through uterus weight increase test of female young mice and endometrium translation examination of female young rabbits. Radialized receptor analysis was used to determine the effect of the triphasic contraceptive tablets on progestogen receptor by the uterus histiocyte from the adult female rabbits whose ovaries had been taken away a week ago. Results Compared with the negative control, triphasic contraceptive tablets kalirui andtrinordiol in three phase groups not only enhanced uterus weight of female young mice, middle and high dose groups obviously accelerated the uterus weight increase ( P

A Case of Baclofen-induced Encephalopathy

We report a case of acute transient encephalopathy with mental alteration, myoclonic jerks, and periodic triphasic wave electroencephalographic patterns caused by a therapeutic dose of baclofen. The clinical and electroencephalo-graphic abnormalities improved to a normal range shortly after baclofen was discontinued. We discuss the pathogenesis and review the literature about baclofen-induced encephalopathies.

Shoulder Pain in the Hemiplegia: Causative Factors and Radiologic Finding

Shoulder pain is the one of the most frequent and serious complicatsion in hemiplegia, which impedes effective rehabilitation. A prospective study was performed to evaluate the shoulder pain, related causative factors and radiologic findings in 35 stroke patients. Triphasic bone scan and simple radiologic evaluation of shoulder were performed at the beginning of rehabilitation treatment. The degree of shoulder pain, spasticity, passive range of motion (ROM) and subluxation were evaluated weekly and followed up for at least 3 months. The incidence of shoulder pain was 62.9%(22/35). It developed in 5.7+/-.7 weeks after the onset of stroke. The muscle tone was increased slightly and mean modified Ashworth scale was 0.77+/-.69 at the onset of shoulder pain. The duration of flaccid stage was longer in patients with shoulder pain than in patients without shoulder pain. The degree of spasticity was inversely correlated well with shoulder pain(r=-0.43, P<0.05). The shoulder pain was also correlated well with the degree of uptake in triphasic bone scan(r=0.61, P<0.05). The more limited ROM of shoulder presented, the more severe pain was. However, there was no relationship between shoulder pain and the degree of subluxation. Therefore, a special precaution is needed to prevent shoulder pain in flaccid stage and the triphasic bone is a useful study in predicting shoulder pain in hemiplegic patients.