The postictal state is defined as an abnormal state at the end of an epileptic seizure and it is characterized by motor, behavioral and neuropsychological symptoms. Depending on the type of seizure and other factors, the postictal state may last from minutes to hours, which is why the diagnosis is based on patient history and clinical criteria supported by electroencephalographic studies.
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  . 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  . 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, paranoia, mood disorders, aggression and disorders of thought  . 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  .
- 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 .
- 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 .
Severe, potentially recurrent headaches after seizures may also be reported by some individuals, and they are frequently misdiagnosed as migraines , while epilepsy occurring exclusively during sleep can induce confusion or sleepwalking, which could be the only symptoms of a postictal state in such circumstances .
Entire Body System
Epilepsy Behav. 2010 Oct;19(2):146-50. doi: 10.1016/j.yebeh.2010.06.022. Epub 2010 Aug 14. [ncbi.nlm.nih.gov]
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]
It is the period following a seizure, which sometimes includes a headache, confusion, soreness or fatigue. [omicsonline.org]
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]
The patient has a history of epilepsy secondary to his stroke. [statpearls.com]
The following chapters cover the therapy of seizures when they develop after traumatic brain injury or stroke, and the treatment of concomitant depression and anxiety in patients with epilepsy. [books.google.com]
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Ohtahara Syndrome Information sheet compiled by the National Institute of Neurological Disorders and Stroke. December 7, 2016 at 15:45:07 UTC " Health ... Epilepsy " search on: [dmoztools.net]
Excessive daytime somnolence - eg, due to a sleep apnoea or narcolepsy. Periodic limb movement disorder. Tardive dyskinesia. Panic attacks. [patient.info]
Postictal patients may also be confused or combative, especially as they transition from somnolent to awake. The postictal phase may last a few minutes to several hours, but patients usually fully recover after 20 minutes. [ems1.com]
somnolent? if so, for how long?). Physical Examination Vital signs and blood sugar should be obtained immediately on all patients. As discussed previously, empiric thiamine should be given when treating hypoglycemia. [unboundmedicine.com]
Side effects: nystagmus, dizziness, somnolence, drowsiness. D. Promote physical and emotional health. Establish regular routines for eating, sleeping, and physical activity. Avoid alcohol, stress, and excessive fatigue. [brilliantnurse.com]
There were some problems with adherence to medication i.e. the patient would reduce dosage on her own when there was worsening of psychotic symptoms, either because of somnolence or because the AED were "the Devil's medicine". [scielo.br]
Stupor and "twitching" Case #5 A 56-year-old man who was previously well was admitted to the hospital in a stupor with clonic twitching of his left extremities and face. [dartmouth.edu]
The stuporous type is characterized by stupor, mutism, posturing and negativism. A third type is lethal or malignant catatonia: an often acutely emerged state involving alterations in consciousness, fever, severe rigidity and autonomous instability. [bmcpsychiatry.biomedcentral.com]
[…] twitching or blinking or other eye movement signs and/or fluctuating mental status Patients in whom no other cause is available to explain the altered sensorium, especially in those who have a history of a previous seizure, even if remote Unexplained stupor [lifeinthefastlane.com]
Clinical presentation varies from mild forms to stupor or coma and can easily be mistaken for catatonia. Patients seem apathetic and lethargic as they can still eat, drink, dress themselves, and follow simple commands . [hindawi.com]
- Altered Mental Status
If a patient remains confused for longer than 20 minutes after a seizure, consider another cause of altered mental status . [ems1.com]
Alcohol withdrawal Patients that present with seizures from alcohol withdrawal (delirium tremens) may present with anxiety, tremulousness, and altered mental status. [cdemcurriculum.com]
Nonconvulsive seizure is a rare presentation of altered mental status (AMS) but should always be on the differential of the comatose patient. Electroencephalography (EEG) is the diagnostic modality of choice for identifying these patients. [emedicine.com]
Altered mental status due to metabolic or endocrine disorders. Emerg Med Clin North Am. 2005;23:901–8. [PubMed] [Google Scholar] 6. Sheth RD, Drazkowski JF, Sirven JI, Gidal BE, Hermann BP. Protracted ictal confusion in elderly patients. [ncbi.nlm.nih.gov]
mental status in whom no other cause is available to explain the altered sensorium Paradoxical response (improved alertness) in a patient with altered sensorium who receives anti-epileptic therapy (e.g. benzodiazepine, propofol) RISK FACTORS Systemic [lifeinthefastlane.com]
- Agitated Delirium
Some patients with prolonged, moderately agitated delirium can be treated for several days with quetiapine fumarate (Seroquel). [ncbi.nlm.nih.gov]
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 . 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  . 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 . 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.
- Theodore WH. Effects of age and underlying brain dysfunction on the postictal state. Epilepsy Behav. 2010;19(2):118-120.
- Bromfield EB, Cavazos JE, Sirven JI, editors. An Introduction to Epilepsy [Internet]. West Hartford (CT): American Epilepsy Society; 2006. Chapter 2, Clinical Epilepsy.
- Krauss G, Theodore WH. Treatment strategies in the postictal state. Epilepsy Behav. 2010;19(2):188-190.
- Rémi J, Noachtar S. Clinical features of the postictal state: correlation with seizure variables. Epilepsy Behav. 2010;19(2):114-117.
- Bazil CW. Effects of sleep on the postictal state. Epilepsy Behav. 2010 Oct;19(2):146-50
- Devinsky O. Postictal Psychosis: Common, Dangerous, and Treatable. Epilepsy Currents. 2008;8(2):31-34.
- Fisher RS, Engel JJ Jr. Definition of the postictal state: when does it start and end? Epilepsy Behav. 2010;19(2):100-104.