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Electrographic Features of Lateralized Periodic Discharges Stratify Risk in the Interictal–Ictal Continuum

Newey, Christopher R.*; Sahota, Pradeep*; Hantus, Stephen†,‡

Journal of Clinical Neurophysiology: July 2017 - Volume 34 - Issue 4 - p 365–369
doi: 10.1097/WNP.0000000000000370
Original Research

Purpose: To risk-stratify electrographic features of lateralized periodic discharges (LPDs) in acute structural brain lesions for predictors of electrographic seizures.

Methods: This is a retrospective review of 100 consecutive patients with LPDs. Epileptiform features of LPDs were described based on electrographic features: blunt delta morphology, sharply contoured, overlying fast frequencies, and/or rhythmicity (loss of interdischarge interval lasting ≥1 second). EEG seizures were defined as evolving in frequency, distribution, or morphology at ≥2 Hz for ≥10 seconds.

Results: Overall, electrographic seizures occurred in 55% of patients with LPDs. Lateralized periodic discharges with rhythmicity (odds ratio 13.91) were most significant for predicting status epilepticus and/or seizures. This was followed by LPDs with overlying faster frequencies (odds ratio 5.16) and then sharply contoured morphology (odds ratio 4.09). Blunt delta morphology (0.24) had the lowest risk for seizures.

Conclusions: Electrographic features of LPDs may help determine seizure risk in patients with acute structural lesions. Sharply contoured morphology, overlying fast frequencies, or rhythmicity, showed progressively higher risk of seizures on continuous electroencephalography, whereas blunt delta morphology had the lowest risk of seizures.

*Department of Neurology, University of Missouri, Columbia, Missouri, U.S.A.;

Cleveland Clinic, Epilepsy Center, Neurological Institute, Cleveland, Ohio, U.S.A.; and

Cleveland Clinic, Cerebrovascular Center, Neurological Institute, Cleveland, Ohio, U.S.A.

Address correspondence and reprint requests to Christopher R. Newey, DO, MS, Department of Neurology, University of Missouri Health System, 5 Hospital Drive, CE 540, Columbia, MO 65201, U.S.A.; e-mail:

S. Hantus has served as a consultant and on advisory boards for UCB Pharma. The remaining authors have no funding or conflicts of interest to disclose.

© 2017 by the American Clinical Neurophysiology Society