Postictal state

The postictal state is the altered state of consciousness after an epileptic seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures, and is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting symptoms. Additionally, emergence from this period is often accompanied by amnesia or other memory defects. It is during this period that the brain recovers from the trauma of the seizure. The postictal state is the altered state of consciousness after an epileptic seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures, and is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting symptoms. Additionally, emergence from this period is often accompanied by amnesia or other memory defects. It is during this period that the brain recovers from the trauma of the seizure. The ictal period is the seizure itself; the interictal period is the time between seizures, when brain activity is more normal; and the preictal period is the time leading up to a seizure. Jerome Engel defines the postictal state as 'manifestations of seizure-induced reversible alterations in neuronal function but not structure.' Commonly after a seizure, a person feels mentally and physically exhausted for up to one or two days. The most common complaint is an inability to think clearly, specifically 'poor attention and concentration, poor short term memory, decreased verbal and interactive skills, and a variety of cognitive defects specific to individuals.' This collection of symptoms is known as the postictal state, the word postictal meaning “after the seizure”. Postictal migraine headaches are a major complaint among persons with epilepsy, and can have a variety of etiologies. One possible cause of these migraines is high intracranial pressure resulting from postictal cerebral edema. At times, a person may be unaware of having had a seizure, and the characteristic migraine is their only clue. Feeling depressed is also very common after a seizure. Postictal anxiety may occur, especially in persons who have either never experienced a seizure before, or that type of seizure before. Other symptoms associated with the postictal state are less common. Todd's paresis is a temporary regional loss of function in whatever region just experienced the seizure, and its manifestation depends on where the seizure was located. Loss of motor function is most common, and can range from weakness to full paralysis. About 6% of patients who had tonic-clonic seizures experienced Todd's paresis afterward, with loss of motor function sometimes accompanied with temporary numbness, blindness, or deafness. Todd's paresis can also cause anterograde amnesia if the seizure included the bilateral hippocampi, and aphasia if the seizures began in the language-dominant hemisphere. Symptoms typically last about 15 hours, but can continue for 36 hours. Postictal psychosis is a neuropsychiatric sequel to seizures of chronic epilepsy in adults. Tending to occur with bilateral seizure types it is characterized by auditory and visual hallucinations, delusions, paranoia, affective change, and aggression. Following the typical postictal confusion and lethargy, the person gradually recovers to a normal lucid state. In persons who experience postictal psychosis, this 'lucid phase' usually continues at least 6 hours (and up to a week) followed by the psychosis lasting 12 hours to more than 3 months (the mean is 9–10 days). The psychosis is typically treated medically using atypical antipsychotics and benzodiazepines, and successful epilepsy surgery can resolve the psychotic episodes. Postictal bliss or euphoria is also reported following seizures. This has been described as a highly blissful feeling associated with the emergence from amnesia. Feelings of depression before a seizure may lead to postictal euphoria. Some of postictal symptoms are almost always present for a period of a few hours up to a day or two. Absence seizures do not produce a postictal state and some seizure types may have very brief postictal states. Otherwise the lack of typical postictal symptoms, such as confusion and lethargy following convulsive seizures, may be a sign of non-epileptic seizures. Usually such seizures are instead related to syncope or have a psychogenic origin ('pseudoseizures'). The postictal state can also be useful for determining the focus of the seizure. Decreased verbal memory (short term) tends to result from a seizure in the dominant hemisphere, whereas seizures in the non-dominant hemisphere tend to manifest with decreased visual memory. Inability to read suggests seizure foci in the language areas of the left hemisphere, and 'after a seizure semivoluntary events as mundane as nose wiping tend to be done with the hand ipsilateral to the seizure focus.'