Is there a post-ictal (after seizure) period?

Post-Ictal Period in Seizures

Yes, there is a post-ictal period following seizures during which a person appears tired and confused for several minutes after the seizure activity has stopped. 1

Characteristics of the Post-Ictal Period

• Most seizures are followed by a postictal period characterized by fatigue, confusion, and altered mental status that typically lasts for several minutes 1
• The postictal period encompasses clinical, biological, electroencephalographic, and imaging changes that follow the termination of a seizure 2
• Postictal symptoms begin as soon as the epileptic discharge ends but may persist for a variable duration 2
• The postictal state can provide valuable information for localizing the seizure onset zone in patients with focal epilepsy 3

Common Post-Ictal Symptoms

Physical Symptoms

• Postictal hemiparesis (weakness on one side of the body) 3
• Postictal nose wiping (lateralizing sign) 3
• Headache (occurs in approximately 33% of patients) 4
• Fatigue (reported in 37% of patients with refractory partial epilepsy) 5
• Neurovegetative symptoms (reported in 52% of patients with refractory partial epilepsy) 5

Cognitive and Psychiatric Symptoms

• Postictal language dysfunction 3
• Postictal cognitive impairment 3
• Postictal depression symptoms (occur in 43% of patients with refractory partial epilepsy) 5
• Postictal anxiety symptoms (occur in 45% of patients with refractory partial epilepsy) 5
• Postictal psychotic symptoms (occur in 7% of patients with refractory partial epilepsy) 5
• Hypomanic symptoms (occur in 22% of patients with refractory partial epilepsy) 5

Duration of Post-Ictal Period

• Most postictal symptoms typically last less than 24 hours 4
• Physical symptoms usually resolve more quickly than cognitive/behavioral symptoms, which can last up to 2 months in some cases 4
• The severity of interictal psychiatric and cognitive symptoms commonly worsens during the postictal period 5

Clinical Significance and Management

• First aid providers should activate EMS if the individual does not return to baseline within 5 to 10 minutes once seizure activity has stopped 1
• Patients should remain NPO (nothing by mouth) until swallowing screening is completed to prevent aspiration 6
• Swallowing assessment should ideally be done within 24 hours of hospital arrival 6
• Risk factors for early seizure recurrence include age ≥40 years, alcoholism, hyperglycemia, and Glasgow Coma Scale score <15 6
• Patients should be monitored for changes in neurological status during the postictal period 6

Special Considerations

• Prolonged postictal states may indicate more severe seizures or underlying neurological issues 7
• A history of depression and anxiety significantly increases the likelihood of experiencing postictal depression, anxiety, and psychotic symptoms 5
• Most patients with refractory partial epilepsy experience more than one type of postictal psychiatric symptom 5
• The postictal period can help differentiate epileptic seizures from non-epileptic events 2

The post-ictal period is an important clinical phase following seizures that requires appropriate monitoring and management to ensure patient safety and recovery.