Triphasic waves: To treat or not to treat?

Generalized periodic discharges (GPDs) with triphasic morphology (triphasic waves, TWs) are EEG waveforms that have been a frequent topic of research evaluating their etiology and clinical correlates. More specifically, prior studies have tried to better elucidate their implications regarding seizures to help guide decision making regarding empiric treatment and EEG monitoring and in spite of multiple studies, controversies remain due to disparate findings. In this review we discuss the historical views of TWs and their clinical and radiographic correlates, highlight the typical and atypical features of TWs, discuss the controversy related to the association between TWs and seizures, and propose an approach to their management.