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       :
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 .
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.