Numerous signs and symptoms may appear in a postictal state, with some variations depending on the underlying type of epilepsy. For example, the duration of symptoms is significantly shorter if seizures originate from the temporal and frontal lobes (about 90 seconds), while tonic-clonic seizures may be followed by a postictal state lasting for hours [1] [2]. Additionally, a prolonged duration of seizures, age extremes (elderly and children) and seizures of the dominant hemisphere are established risk factors for a prolonged postictal state [1] [3]. Regardless of the duration, the following symptoms are encountered [1] [2] [3] [4] [5] [6] [7]:

• Behavioral changes - Postictal psychosis is one of the most important behavioral manifestations of the postictal state, distinguished by auditory and visual hallucinations, delusions, paranoia, mood disorders, aggression and disorders of thought [1] [3]. A rapidly resolving delirium is another important feature, but a severe and prolonged form is seen in more than a third of cases, presenting as alterations in the sleep-wake cycle, attention deficits, and increased autonomic activity [3] [6].
• Alterations in motor function - Weakness and/or paralysis, usually unilateral and contralateral to the seizure focus, can last for minutes or even hours, depending on the extent of brain damage after seizures. Patients who suffer from structural lesions (caused by a tumor or stroke) seem to be most susceptible [1].
• Cognitive and visual symptoms - Dysphasia, homonymous hemianopias or blindness, respectively, are also encountered during the postictal state, and they seem to be more common during childhood and when seizures stem from the occipital or occipitotemporal lobes [1].

Severe, potentially recurrent headaches after seizures may also be reported by some individuals, and they are frequently misdiagnosed as migraines [3], while epilepsy occurring exclusively during sleep can induce confusion or sleepwalking, which could be the only symptoms of a postictal state in such circumstances [5].

• Epilepsy

  Epilepsy Behav. 2010 Oct;19(2):146-50. doi: 10.1016/j.yebeh.2010.06.022. Epub 2010 Aug 14. [ncbi.nlm.nih.gov]

  […] and surgery on behavior Pediatric and adolescent epilepsy Disorders associated with epilepsy that impact behavior And much more [books.google.com]

• Falling

  Patients should be protected from harm by keeping them from sharp objects and possibly falling off an unsafe surface. [limmereducation.com]

  The whole body stiffens (tonic phase) and the person loses consciousness and falls. This is followed by a violent uncontrollable shaking (clonic phase). Absence seizure is another type of generalized seizure. [epilepsytalk.com]

  The onset may be so sudden that the patient falls to the ground, or so subtle that the seizure looks like a tremor. Publication Review By: Gordon R. Kelley, M.D. Published: 31 Jan 2002 Last Modified: 14 Sep 2015 [healthcommunities.com]

  These can often lead to falls. At times, it is hard to tell visually whether the child fell due to loss of tone (atonic seizure) or stiffening (tonic seizure). [cincinnatichildrens.org]

  If clinical evidence suggests that patients fall into a postictal state, further workup must include electroencephalography (EEG). [symptoma.com]

• Fatigue

  He or she may be able to help you find out what's causing your fatigue and recommend ways to relieve it. Read more on MedlinePlus.gov. [treato.com]

  Postictal phase : Fatigue, lethargy, and exhaustion follow the pain phase for migraine and the seizure phase for and epilepsy. This is the stage that’s often called a migraine hangover. [theraspecs.com]

  Many people who have seizures may feel fatigued or sleepy for hours or even days after having a seizure. [verywellhealth.com]

  Related to Physical Agents 397 Injury and Poisoning 404 Care of Acute Lacerations 421 Selected Injuries 435 Care of the Athlete 444 Athletic Injuries 453 Common Clinical Problems 465 Care of the Patient with Dysequilibrium 471 Care of the Patient with Fatigue [books.google.ro]

  […] uttering of an “ ictal cry” Increased sympathetic tone: dilated, unresponsive pupils, ↑ HR and ↑ blood pressure Clonic phase (rhythmic muscle twitching) Bladder or bowel incontinence Tongue bite lacerations Unresponsiveness Confusion Amnesia Aphasia Fatigue [amboss.com]

• Unconsciousness

  While unconscious, the patient may have "vacant" or "frightened" look and may have signs and symptoms of a simple partial seizure. Automatisms may occur during unconsciousness. [healthcommunities.com]

  […] by, Last updated May 31, 2012 Overview A useful way of approaching the unconscious patient is to use these three categories: Coma with focal or lateralising signs Coma without focal or lateralising signs but with meningism Coma without either focal or [lifeinthefastlane.com]

  Some people will also fall unconscious as with a tonic-clonic seizure. References External links Epilepsy & Seizures on NeurologyChannel [wikidoc.org]

  In one study, Todd’s paralysis lasted longer in people that were unconscious during seizure activity. You don’t have to be unconscious during a seizure for Todd’s paralysis to happen afterward, however. [healthline.com]

  This duration was probably longer than that of true unconsciousness, as it involved not just unconsciousness but also the period immediately afterwards in which subjects failed to reply to oral requests. [academic.oup.com]

• Gagging

  Kevin froze but snapped out of it when Sam's next gag and spit into the bowl made his grip on Kevin's wrist tighter. Kevin wanted to reach out to Sam's head or shoulder but he knew Dean had him. [fanfiction.net]

  Your child can experience a variety of behaviors, such as gagging, lip smacking, running, screaming, crying or laughing. After the seizure, during what’s called the postictal period, your child may feel tired. [childrenshospital.org]

  These behaviors may range from gagging, lip smacking, running, screaming, crying, and/or laughing. When the child regains consciousness, the child may complain of being tired or sleepy after the seizure. This is called the postictal period. [chw.org]

  The gag reflex is also suppressed during a seizure and the patient may aspirate if they vomit. The patient’s upper airway may also be obstructed by their relaxed tongue. Generalized tonic-clonic seizures usually last a few seconds to a few minutes. [ems1.com]

• Fear

  In the second phase the left temporal focal semirhythmic discharges associated with fear bouts became more frequent and prolonged and began to be followed by long-lasting generalized discharges resulting in a trancelike state with severe impairment of [karger.com]

  Fear or anxiety usually is associated with seizures arising from the amygdala. Sometimes, the fear is strong, described as an "impending sense of doom." [emedicine.medscape.com]

  […] something before), jamais vu (feeling that one has never seen something that is familiar), jamais entendu (feeling that one has never heard something that is familiar), panoramic vision (rapid recall of past events) Time distortion Unprovoked emotion: fear [healthcommunities.com]

  Common symptoms after a seizure include: Anxiety Confusion Depression, sadness, upset Difficulty talking or writing Embarrassment Emotional behavior Exhaustion Fear Feeling fuzzy, light headed or dizzy Frustration General weakness or weak in one part [epilepsytalk.com]

  Psychologically, they experience a feeling of déjà vu or other emotions such as pleasure or fear. Patients may still have a degree of awareness and know that they are having a seizure. Complex Partial Complex partial seizures impair awareness. [neurocenternj.com]

• Visual Hallucination

  Regardless of the duration, the following symptoms are encountered: Behavioral changes - Postictal psychosis is one of the most important behavioral manifestations of the postictal state, distinguished by auditory and visual hallucinations, delusions, [symptoma.com]

  Auditory or visual hallucinations can predominate ( 8, 12, 13, 20, 21 ). [doi.org]

  These visual illusions are unlike the visual hallucinations associated with occipital lobe seizure in that no formed elementary visual image is noted, such as the visual image of a face that may be seen with seizures arising from the fusiform or the inferior [emedicine.medscape.com]

  These visual illusions differ from the visual hallucinations associated with occipital lobe seizure in that there is no formed visual image. Objects may appear smaller or larger than usual. [patient.info]

• Psychiatric Manifestation

  Psychiatric manifestations or automatisms were rare. The presumed etiology was due to diverse causes, but a withdrawal state was the most common. EEG demonstrated continuous or nearly continuous generalized ictal discharges of variable morphology. [neurology.org]

  Psychiatric manifestations in TLE: a controlled study. Br J Psychiatry 1979;135:411-417. [ Links ] 33. Roberts GW, Done DJ, Bruton C, Crow TJ. A "mock up" of schizophrenia: temporal lobe epilepsy and schizophrenia-like psychosis. [scielo.br]

  Misdiagnoses, namely, labeling secondary psychiatric syndromes with primary psychiatric diagnoses, usually derive from limited understanding of the diverse manifestations of epileptic seizures and could probably be grouped into(i)psychosis/schizophrenia [hindawi.com]

• Social Isolation

  Unfortunately, just as troubling as the physical complications, seizures can also cause embarrassment and social isolation. What are the different types of seizures? Children experience many different types of seizures. [childrenshospital.org]

  Many patients with TLE remain unemployed, facing social or personal isolation [114, 115]. [hindawi.com]

• Incontinence

  In the postictal phase drooling; biting of the tongue, cheek, or lip; and urinary incontinence are common. When the jerking movements stop, the patient may remain unconscious for a period of time. The seizure usually lasts 5 to 20 minutes. [healthcommunities.com]

  It's not uncommon for patients having these types of seizures to bite their tongue or suffer urinary incontinence. Absence During an absence seizure, patients usually have a blank expression. [neurocenternj.com]

  (d) Observe and record time of onset, duration, characteristics of the seizure, and if the patient was incontinent of stool or urine CAUTION: If the casualty's teeth are clenched, do not attempt to forcibly open the casualty's jaw. [medtrng.com]

  Clonic Phase: The patient has convulsions and might suffer from oral trauma or incontinence. Their breathing might be shallow or absent. This phase lasts approximately 30 seconds to 5 minutes. Postictal State: This is known as the recovery phase. [emtresource.com]

  Common findings include postictal confusion that resolves while in the ED, evidence of tongue trauma from biting, and urinary or bowel incontinence. [cdemcurriculum.com]

• Urinary Incontinence

  It's not uncommon for patients having these types of seizures to bite their tongue or suffer urinary incontinence. Absence During an absence seizure, patients usually have a blank expression. [neurocenternj.com]

  In the postictal phase drooling; biting of the tongue, cheek, or lip; and urinary incontinence are common. When the jerking movements stop, the patient may remain unconscious for a period of time. The seizure usually lasts 5 to 20 minutes. [healthcommunities.com]

  During grand-mal seizures, injuries and accidents may occur, such as tongue biting and urinary incontinence. [medicinenet.com]

  Specifically, lateral tongue biting and urinary incontinence are more suggestive of an actual seizure than a syncopal event. 7 Always follow an organized approach to rule out all possible causes and don’t let past medical history lead you to a premature [limmereducation.com]

  In an attempt to clinically differentiate psychogenic from nonpsychogenic seizure activity, one needs to bear in mind that classic grand mal tonic-clonic presentation with tongue biting, urinary incontinence, and complete unresponsiveness during the ictal [hindawi.com]

• Generalized Seizure

  Generalized tonic-clonic seizures (grand mal) are the most familiar and dramatic of the generalized seizures. They begin with abrupt loss of consciousness without warning or aura. [accessmedicine.mhmedical.com]

  Atonic Loss of muscle tone Generalized seizures There are six types of generalized seizures. The most common and dramatic, and therefore the most well known, is the generalized convulsion, also called the grand-mal seizure. [medicinenet.com]

  Generalized seizures is almost always associated with impaired consciousness generalized tonic-clonic (grand mal) seizures is the most common type of generalized seizure Generalized Seizure Types Seizure Type Clinical Features Absence (petit mal seizures [step1.medbullets.com]

  Focal seizures without dyscognitive features Focal seizures with dyscognitive features Primary generalized seizures Classic tonic‑clonic seizur es (see grand mal seizure ) Further generalized seizures Absence (see also generalized epilepsies in childhood [amboss.com]

  A period of confusion is common after a generalized seizure, also known as a grand mal seizure. [livestrong.com]

• Stroke

  The patient has a history of epilepsy secondary to his stroke. [statpearls.com]

  WEBSITES National Institute of Neurological Disorders and Stroke (NINDS). Todd's Paralysis Fact Sheet. Bethesda, MD: NINDS, 2003.. Rosalyn Carson-DeWitt, MD [encyclopedia.com]

  The symptoms are similar to those of a stroke, but the two conditions are vastly different. Both strokes and seizures impact the function of your brain. The symptoms of Todd’s paralysis resolve themselves within 48 hours. [healthline.com]

  Apoplexy: stroke, SAH, extradural, subdural, Ca, meningitis, encephalitis, cerebral abscess, etc. [lifeinthefastlane.com]

• Lip Smacking

  >Following the aura, a temporal lobe complex partial seizure begins ->> wide-eyed ->>> motionless stare ->>>> dilated pupils ->>>>> behavioral arrest, ‘oral alimentary automatisms’ ‘lip smacking + chewing. [lopezdonado.bandcamp.com]

  Common automatisms include lip smacking, chewing, fidgeting and walking. QUESTION If you have had a seizure, it means you have epilepsy. [medicinenet.com]

  They may also exhibit repetitive movements, which include lip-smacking, fidgeting, or chewing. If you or someone you love is suffering from seizures, you aren't alone. Contact Dr. [neurocenternj.com]

  These seizures may occur multiple times throughout a day and induce subtle body movements, such as eye-blinking or lip-smacking. Tonic seizures: These seizures cause stiffening of the back, arms and legs muscles. [limmereducation.com]

  The seizure usually starts with a blank stare, followed by an automatism such as lip smacking, chewing, rolling of the fingers, fidgeting or some other repetitive movement. The patient will appear dazed and will not to respond to any commands. [emtresource.com]

• Meningism

  Apoplexy: stroke, SAH, extradural, subdural, Ca, meningitis, encephalitis, cerebral abscess, etc. [lifeinthefastlane.com]

  Choose one to reveal diagnosis and discussion Closed head injury (concussion, intracranial bleed) Infection (eg, meningitis) Metabolic causes (diabetic ketoacidosis) More Cases ReelDx Video Case Challenge ReelDx Video Case Challenge ReelDx Video Case [thedoctorschannel.com]

  Differential Diagnosis Differential Diagnosis of Seizures in general (VITAMIN) V ascular – Hypoxic-Ischaemic encephalopathy I nfection – Meningitis/Encephalitis T emperature – Febrile Seizure A bnormality of the CNS M etabolic Disturbance – Hypoglycemia [armandoh.org]

  Antibiotics may be given to prevent meningitis. D. Hematoma. Epidural—most serious; hematoma between dura and skull from tear in meningeal artery; forms rapidly. Subdural—under dura; due to tears in veins crossing subdural space; forms slowly. [brilliantnurse.com]

  No further work-up is necessary, but lumbar puncture is indicated in patients with suspected meningitis. [aafp.org]

• Tremor

  Some signs that your child may be experiencing seizures include: staring tremors, convulsions or jerking movements in the arms and legs stiffening of the body loss of consciousness breathing problems loss of bowel or bladder control falling suddenly for [childrenshospital.org]

  […] purposeful movements (person may continue activity that was going on before the seizure) Rigid or tense muscles (part of the body or whole body may feel very tight or tense and if standing, may fall “like a tree trunk”) Sensations in the stomach Sweating Tremors [epilepsytalk.com]

  The onset may be so sudden that the patient falls to the ground, or so subtle that the seizure looks like a tremor. Publication Review By: Gordon R. Kelley, M.D. Published: 31 Jan 2002 Last Modified: 14 Sep 2015 [healthcommunities.com]

  […] drooling Repeated blinking of eyes, eyes may move to one side or look upward, or staring Lack of movement or muscle tone (unable to move, loss of tone in neck and head may drop forward, loss of muscle tone in body and person may slump or fall forward) Tremors [epilepsy.com]

To confirm the diagnosis of a postictal state and to confirm its symptoms as being a consequence of epilepsy, a thorough patient history, and a detailed physical examination must be conducted, as various conditions may mimic the clinical presentation [3]. Firstly, details regarding prior treatment with antipsychotic medications, alcohol abuse, use of antiepileptic therapy that can exert side-effects, and recent exposure to illicit drugs must be noted, in order to exclude iatrogenic causes of delirium and psychosis [3] [6]. A complete neurological examination should follow, during which weakness, paralysis or other pathological phenomena can be encountered. If clinical evidence suggests that patients fall into a postictal state, further workup must include electroencephalography (EEG). A nonconvulsive status while symptoms are still present, is considered to be a diagnostic hallmark of the postictal state, but interictal spikes and spike-waves may be present as a remnant of a seizure [7]. Because imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI) are of limited use, the diagnosis of a postictal state relies on excluding other causes through patient history, clinical criteria and EEG studies.

• Polyspike-and-Slow-Waves

  EEG shows 5-Hz polyspike and slow-wave discharges. [step1.medbullets.com]

  EEG may detect epileptiform abnormalities (spikes, sharp waves, spike and slow-wave complexes, polyspike and slow-wave complexes). [msdmanuals.com]

  EEG typically shows generalized slow spike-wave or polyspike-and-slow-wave complexes. It should be noted that epileptic drop attacks may occur not just with atonic seizures, but also with myoclonic or tonic seizures if the legs are involved. 2d. [ncbi.nlm.nih.gov]

• 3-4 Hz Spikes

  4-Hz spike and wave discharges Myoclonic Patients can present with quick and repetitive jerks Tonic-clonic Typically begins with a tonic phase contraction of all muscles for 10-15 seconds leads to a fall "like a tree" The clonic phase follows the tonic [step1.medbullets.com]

• 3-Hz Spike-Wave Discharges

  The EEG signature of absence epilepsy is the generalized 3 Hz spike-wave discharge ( Slide 10 ). Children with typical absence seizures usually have normal development and intelligence. [ncbi.nlm.nih.gov]

• Hyponatremia

  […] can be divided into provoked and unprovoked causes provoked substance abuse ( e.g., cocaine and MDMA) space occupying lesion ( e.g., malignancy and abscess) stroke ( e.g., ischemic and hemorrhagic) meningitis and encephalitis hypo- or hyperglycemia hyponatremia [step1.medbullets.com]

  Some etiologies of seizure have specific treatments: Eclampsia – Magnesium sulfate Hyponatremia – Hypertonic saline Isoniazid – Pyroxidine Hypoglycemia – Dextrose Disposition All patients presenting to the ED with seizure must have appropriate outpatient [cdemcurriculum.com]

  Complications Status epilepticus Criteria ≥ 5 min of continuous seizures OR ≥ 2 seizures with consciousness not being fully regained in the interictal period Etiology Common causes are withdrawal from antiepileptic drugs ;, metabolic disturbances ; (e.g., hyponatremia [amboss.com]

  Again, correctable causes for seizures (e.g., hyponatremia, drug toxicity, alcohol withdrawal) do not require long-term anticonvulsant therapy. [unboundmedicine.com]

• Hyperglycemia

  Common Causes of Seizures Hypertension Fever Poisoning Infection Hypoglycemia / Hyperglycemia Head injury Hypotension Stroke Hypoxia Eclampsia Drug or alcohol withdrawal Dysrhythmias Electrolyte imbalance A patient who experiences seizures lasting longer [emtresource.com]

  […] successions Etiology can be divided into provoked and unprovoked causes provoked substance abuse ( e.g., cocaine and MDMA) space occupying lesion ( e.g., malignancy and abscess) stroke ( e.g., ischemic and hemorrhagic) meningitis and encephalitis hypo- or hyperglycemia [step1.medbullets.com]

  The major laboratory finding was hyperglycemia (blood glucose 1,100 mg%) in the absence of ketosis. [dartmouth.edu]

Treatment of postictal states requires recognition of underlying neurological and systemic disorders associated with seizures and delirium such as metabolic disorders and nonconvulsive seizures. [ncbi.nlm.nih.gov]

The final chapters discuss emerging topics in epilepsy: the treatment of the postictal state, technologies to predict and detect seizures, strategies for closing the treatment gap and sudden unexpected death in epilepsy. [books.google.com]

[…] recordings of 955 spasms in children with cryptogenic and symptomatic West syndrome (WS) were reviewed to define the relation between a clinical manifestation of a spasm and its EEG pattern, and to examine whether these features reflect the etiology and prognosis [moh-it.pure.elsevier.com]

Prognosis The prognosis of Todd's paralysis is excellent, with full recovery to be anticipated. Resources BOOKS Pedley, Timothy A. "The Epilepsies." Cecil Textbook of Internal Medicine, edited by Lee Goldman, et al. Philadelphia: W.B. [encyclopedia.com]

Implications of NCSE are poorly defined associated with poorer prognosis, however the underlying cause is typically the major determinant of mortality Patients with pre-existing epilepsy have a lower mortality (3%) than where NCSE is due to acute medical [lifeinthefastlane.com]

Discharge Regained full consciousness Provide clear management for any recurrences Provide education, support and follow up with GP Complications and Prognosis Prognosis of epilepsy 50% of childhood epilepsy have a favourable course 25% gradually improve [armandoh.org]

PROGNOSIS The long-term impact of seizures is small for most children, especially if there are no underlying abnormalities in the child's brain. Many children with epilepsy have normal development and a good chance for a normal life. [uptodate.com]

Although it was independent from the etiology of the spasms, persisting hypsarrhythmia during a cluster of spasms appeared to be an EEG pattern that correlated with a favorable outcome. [moh-it.pure.elsevier.com]

Etiology Epilepsy Although these seizures are referred to as unprovoked, they may be triggered by certain provocative factors! [amboss.com]

Adult first generalized seizure: etiology, biological tests, EEG, CT scan, in an ED. Am J Emerg Med. Jan 1995;13(1):1-5. [cdemcurriculum.com]

The results also suggest that the etiology of postictal psychosis in this patient was initiated by an ictal event and the behavior apparently depended on seizure propagation outside the hippocampus. [thejns.org]

The presumed etiology was due to diverse causes, but a withdrawal state was the most common. EEG demonstrated continuous or nearly continuous generalized ictal discharges of variable morphology. [neurology.org]

Causes of epilepsy: contributions of the Rochester epidemiology project. Mayo Clin Proc. 1996;71(6):570–5. PubMed CrossRef Google Scholar 2. Hildebrand J, Lecaille C, Perennes J, et al. [link.springer.com]

These epidemiological results were first reported and stressed by Verrotti et al. [ 15 – 17 ], which conducted in pediatric age. [thejournalofheadacheandpain.springeropen.com]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

Definition References: [1] [2] [3] [4] [5] Epidemiology References: [6] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Epidemiology Focal epilepsy is often of temporal lobe origin but the true prevalence of TLE is not known. Presentation [ 1 ] Aura occurs in the majority of temporal lobe seizures. [patient.info]

Just as the pathophysiology of seizures is complicated, so is that of the PS multifactorial. As a practical issue, it would be very useful to have medications that reduce the morbidity of the PS. [ncbi.nlm.nih.gov]

Definition and Pathophysiology of Epilepsy Seizures (sometimes called epileptic seizures) are the stereotypical clinical manifestations (signs and symptoms) of excessive synchronous, usually self-limited, abnormal electrical activity of neurons situated [pedsinreview.aappublications.org]

Abstract The neuroanatomical and pathophysiological basis of primary generalised absences is uncertain. Administration of endogenous opioids has been shown to result in absence-like seizures in animal models. [pubmedcentral.nih.gov]

The pathophysiologic mechanism of PIP is unknown. One hypothesis is that PIP represents a psychic Todd's paralysis [ 15, 18 ]. [annals-general-psychiatry.biomedcentral.com]

Pathophysiology PP is associated with relatively broadly and bilaterally distributed epileptogenic networks as well as genetic determinants of seizures and psychiatric disorders. [doi.org]

Some of these tests include: Treatment and Prevention The best way to prevent postictal paralysis is by preventing seizures from happening. Seizures can be prevented with anti-epilepsy medications and sometimes with epilepsy surgery. [verywellhealth.com]

Prevent infection. High risk of meningitis, abscess, osteomyelitis, particularly in presence of rhinorrhea, otorrhea. Maintain strict asepsis. I. Prevent complications of immobility. Continue range-of-motion activities. Prevent contractures. J. [brilliantnurse.com]

If this drug is to be withdrawn prior to pregnancy, it must be tapered off slowly (months) to prevent withdrawal seizures. [obgynkey.com]

Deterrence/prevention To date, there have been no data to indicate that any intervention other than medications effectively prevents seizures or SE. Therefore, medication compliance should always be emphasized to every patient. [emedicine.com]

[…] to prevent these from happening in the future. No ER visit. No seizure drugs. No EEG etc. To get the diagnosis wrong—either way—would be to treat the patient inappropriately and perhaps even to harm the patient. So, accurate diagnosis is paramount. [jailmedicine.com]

1. Theodore WH. Effects of age and underlying brain dysfunction on the postictal state. Epilepsy Behav. 2010;19(2):118-120.
2. Bromfield EB, Cavazos JE, Sirven JI, editors. An Introduction to Epilepsy [Internet]. West Hartford (CT): American Epilepsy Society; 2006. Chapter 2, Clinical Epilepsy.
3. Krauss G, Theodore WH. Treatment strategies in the postictal state. Epilepsy Behav. 2010;19(2):188-190.
4. Rémi J, Noachtar S. Clinical features of the postictal state: correlation with seizure variables. Epilepsy Behav. 2010;19(2):114-117.
5. Bazil CW. Effects of sleep on the postictal state. Epilepsy Behav. 2010 Oct;19(2):146-50
6. Devinsky O. Postictal Psychosis: Common, Dangerous, and Treatable. Epilepsy Currents. 2008;8(2):31-34.
7. Fisher RS, Engel JJ Jr. Definition of the postictal state: when does it start and end? Epilepsy Behav. 2010;19(2):100-104.