Understanding the Postictal Phase of a Seizure

Symptoms and EEG Findings During the Postictal Phase

An EEG test is performed on an epilepsy patient.
An EEG test is performed on an epilepsy patient.. BSIP/UIG/Getty Images

The postictal phase of a seizure refers to the period of time after a seizure has occurred. It can last seconds to hours and sometimes days and is commonly thought of as time for the brain to recover from the seizure.

Symptoms During the Postictal Phase

The duration of a postictal phase and the symptoms present are variable. They depend on a number of factors, like where in the brain the seizure is occurring and how long the seizure lasted.

Postictal symptoms include changes in behavior, thinking, and motor function. According to the Epilepsy Foundation, some common postictal symptoms include physical symptoms like fatigue, headache, nausea, feeling thirsty, or weakness all over or in one part of the body, a strong urge to urinate, or a loss of bladder or bowel control.

A person also commonly has mental symptoms during the posictial phase like feeling sleepy, confused, or foggy. A person may also feel sad, anxious, or embarrassed. Difficulty walking or talking and experiencing memory loss may also occur.

As a result of a seizure, a person may have injuries from biting his tongue, falling and/or hitting something. These injuries range from small cuts to fractures and head injuries.

Sometimes, the postictal symptoms can help a doctor determine the focus of the seizure, or the location in the brain where it starts. For example, postictal dysphasia, or difficulty speaking, suggests that the seizure originated in that person's dominant hemisphere — the half of the brain that a person favors.

In addition, a postictal condition called Todd's paralysis, or postictal paralysis, occurs on the opposite side of the brain from the seizure focus.

Postictal automatisms may also occur, which are repetitive movements, like lip smacking or nose rubbing. They are commonly a sign of complex partial seizures that frequently arise from the temporal lobe.

EEG During the Postictal Phase

The electroencephalogram, or EEG, of the postictal phase usually shows a slowing of brain activity on the side of the brain where the seizure occurred. That being said, it can be difficult sometimes to distinguish between the ictal phase and the postictal phase when looking at an EEG, as brain slowing activity may be seen during both phases.

In addition, the brain wave changes on an EEG do not always correlate with a person's behavioral changes. This is why some doctors focus more on describing a person's behavior and EEG changes during and after a seizure, as opposed to labeling ictal and postictal phases

Final Thought

While it's a good idea to understand the terminology used to describe a seizure, try not to get too hung up on it. When a person is having a seizure, there may be some overlap between phases, as well as ambiguity between a person's symptoms and what the EEG shows. Speak with your doctor about your symptoms and share your thoughts — this can sometimes be the most helpful to your doctor when understanding your seizure disorder.

Sources:

Epilepsy Foundation. (2014). What Happens During a Seizure? 

Fisher RS & Engel JJ Jr. Definition of the postictal state: when does it start and end? Epilepsy Behav. 2010 Oct;19(2):100-4.

Rémi J & Noachtar S. Clinical features of the postictal state: correlation with seizure variables. Epilepsy Behav. 2010 Oct;19(2):114-7.

Theodore WH. The postictal state: effects of age and underlying brain dysfunction. Epilepsy Behav. 2010 Oct;19(2):118-20.

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