Postictal State

Seizures are sudden, uncontrolled electrical disturbance in the brain, which causes changes in movement, feelings, behaviours and levels of consciousness.

They are the primary symptom of epilepsy. People living with epilepsy experience not only these symptoms but also the aftermath of seizures – known as the postictal state. 

The postictal state is a condition begins when a seizure subsides, marking the termination of a seizure and the patient’s return to consciousness.

It typically lasts between 5-30 minutes, but can sometimes last longer depending on the severity of the seizure. The postictal state is characterized by symptoms which include nausea, confusion, drowsiness, headache, hypertension or migraine.

Amnesia and other memory defects also commonly occur during this period as the brain recovers from the trauma of the seizure. 

Other states of a seizure include:

  • Ictal period refers to the actual seizure or stroke. The word originates from the Latin word ictus, meaning a blow or a stroke.
  • Pre-ictal refers to the state immediately before the actual seizure or stroke.
  • Post-ictal refers to the state shortly after the event.
  • Interictal refers to the period between seizures that are characteristic of an epilepsy disorder. For most people with epilepsy, the interictal state takes up the majority of their lives. Neurologists use this period when diagnosing epilepsy since an electroencephalography (EEG) trace will often show small interictal spiking and other abnormalities known by neurologists as subclinical seizures. 
  • Peri-ictal encompasses pre-ictal, ictal and post-ictal.

Signs and Symptoms of the Postictal State

The symptoms of the postical state are mostly dependent on the severity of the seizure and the part of the brain involved.

The symptoms can affect changes in thinking, movement, behaviour and mood.

They include:

  • Memory loss
  • Headache
  • Fatigue
  • Thirst
  • Mental confusion
  • Sleepiness
  • Weakness in part or all the body
  • Nausea
  • Speech or writing impairment
  • Difficulty walking
  • A strong urge to urinate

A person may experience injuries such as head traumas, bruises, bone fractures and bitten tongues resulting from a seizure. They may also experience feelings of agitation, sadness, confusion, anxiety, frustration and embarrassment. Some people experience extreme mental symptoms such as delirium and psychosis, in some cases.

Postictal migraines are a common occurrence among people living with epilepsy. This could occur as a result of the brain swelling that occurs during a seizure, causing intracranial pressure and pain. 

There are cases where a person may only be aware that they’ve had a seizure when a postical migraine appears. 

Postictal bliss or euphoria has also been reported following a seizure. It is described as excessive happiness associated with the emergence from amnesia. 

Postictal symptoms are present for a period of a few hours up to a day or two. 

Postictal symptoms are useful in determining the focus of the seizure—that is, where in the brain the seizure activity started.

Some examples of this include:

  • Postictal dysphasia: Characterized by decreased verbal memory (difficulty speaking), which suggests the seizure originated in your dominant hemisphere. In a right-handed person, that would be the left half of the brain.
  • Postictal paralysis: This is characterized by weakness of a hand or limb associated with the side of the body opposite from the seizure focus in the brain.
  • Postictal automatisms: Involves repetitive actions such as lip-smacking and nose rubbing. These are common signs of complex partial seizures, which frequently arise in the temporal lobe.

Diagnosis and Testing

An electroencephalogram (EEG) often shows reduced brain activity on the focus of the seizure during a postictal phase.

There are, however, times where reduced brain activity occurs in both the ictal and postictal stages, making it difficult to tell the difference between the phases on EEG. Furthermore, changes in the brain-wave on an EEG do not always correlate with a person’s behavioural changes. 

Although it may seem like taking an EEG after a seizure is a waste of time, the event leaves a trail of altered brain activity that helps doctors characterize seizures for better treatment in the future. 

Coping with the Postictal state

Managing and coping with symptoms of the postictal state begins with recognizing the signs and what is unique for a particular person. For example, if a loved one usually has a postictal migraine, their doctor may be able to prescribe medication that you can give them right after a seizure.

Taking care of physical needs (such as thirst), a safe and calm environment, rest, reassurance, and emotional support can all help as well.

If you notice postictal behaviour or symptoms that are not typical for that person, seek medical attention immediately. There may be a severe brain injury or complication.