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.

While the postictal period is considered to be the period shortly after a seizure where the brain is still recovering from the seizure, the ictal period is considered to be the seizure itself, and the interictal period to be the period between seizures, when brain activity is more normal and the preictal period that time before a seizure.

Jerome Engel defines the postictal state as “manifestations of seizure-induced reversible alterations in neuronal function but not structure.” Following a seizure it is common to experience feelings of exhaustion, both mental and physical, that can last for a day or two. Patients’ most common complaint after a seizure 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, though the word postictal means nothing more than “after the seizure”.

Postictal migraines are a major complaint among epilepsy patients, and can have a variety of etiologies. One possible cause of these migraines is high intracranial pressure resulting from postictal cerebral edema. At times, patients may be unaware that they had a seizure, and the characteristic migraine is their only clue.Depression is also very common after a seizure. Especially in those who have never experienced a seizure before, or in those who suffered a seizure of a type unlike previous ones, there may be anxiety.

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