Objective:

The goal of this study is to determine etiologies of generalized periodic discharges with triphasic morphology (GPD+TW) and whether they should be treated with anti-seizure medication (ASM). We hypothesize that there is no significant change in outcomes as measured by hospital length of stay, intensive care unit (ICU) length of stay, or Glasgow coma scale (GCS) in patients with GPD+TW treated with ASM compared to patients who were not.

Background:

GPD+TW are thought to occur secondary to toxic-metabolic encephalopathy. However, there are case series that indicate many different etiologies for these waveforms. While GPD+TW are typically not treated with ASM, there are cases where benzodiazepine challenges are initiated to evaluate for clinical and electrographic improvement. There is a lack of research looking into the outcomes of patients with GPD+TW.

Design/Methods:

We selected patients that were admitted to the ICU and had an EEG from 2013-2023. Patients were included if they were older than 18 years of age, admitted to the ICU, and had an EEG describing GPD+TW. Patients were excluded if they had post-anoxic coma or definite status epilepticus based on clinical and EEG criteria.

Results:

There were 98 patients who met criteria, 42 were treated with ASM and 56 were not. The most common etiologies attributed to GPD+TW were acute kidney injury (24%), acute hepatic injury (22%), and cefepime toxicity (18%). An independent samples t-test found no significant difference in ICU length of stay, hospital length of stay, and GCS among patients who were treated with ASM and those who were not.

Conclusions:

Based on the results, there is no indication that using ASM leads to better outcomes in patients with GPD+TW. However, more research needs to be done to look at a larger population and if the etiology has an impact on outcomes.