Stimulus-Induced Rhythmic or Periodic Intermittent Discharges (SIRPIDs) in patients with triphasic waves and Creutzfeldt-Jakob disease

Philippe Gelisse, Arielle Crespel, Gian Luigi Gigli, Peter W. Kaplan

Research output: Contribution to journalReview articlepeer-review


Since the term Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs) was introduced into the vocabulary of electrophysiologists/neurologists, there has been an ongoing debate about its significance, as well as its correlation with outcomes. SIRPIDs are frequently seen in patients who are critically ill from various causes. The literature reflects the findings of triphasic morphology, with the generalized periodic discharge (GPD) classification in many patients with SIRPIDs: toxic/metabolic encephalopathies, septic, and hypoxemic/hypercapnic encephalopathies, but also sharp periodic complexes in Creutzfeldt-Jakob disease and advanced Alzheimer's disease. In these settings, GPDs disappear when patients fall asleep and reappear when patients spontaneously wake up, or are awoken by an external stimulus, or sometimes because of a respiratory event, with the possibility of the appearance of GPDs with a cyclic alternating pattern. SIRPIDs may be seen as a transitional pattern between sleep and waking states, corresponding to a postarousal/awakening phenomenon. As SIRPIDs are a transient phenomenon and can usually be recorded repeatedly with each stimulation, the word “Ictal” could be replaced by “Intermittent”: Stimulus-Induced Rhythmic or Periodic Intermittent Discharges. However, considering that SIRPIDs may be “potentially ictal” or on an “ictal–interictal continuum“ in some situations, the “plus” modifier may be added: SIRPIDs-plus.

Original languageEnglish (US)
Pages (from-to)1757-1769
Number of pages13
JournalClinical Neurophysiology
Issue number8
StatePublished - Aug 2021


  • Creutzfeldt-Jakob disease
  • Cyclic alternating pattern
  • Sleep-to-wake transition
  • Sleep-wake cycle
  • Triphasic Waves

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


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