The Postictal Phase of a Seizure

The postictal phase refers to the period of time immediately following a seizure. The postictal phase can last for only a few seconds up to sometimes even days. It is commonly thought of as the time during which the brain recovers from a seizure.

This article describes the range of symptoms that can occur in the postictal phase and how to cope. It also covers tests that may be done to help form a diagnosis.

Symptoms of the Postictal Phase

The postictal phase of a seizure is the last stage and can last for seconds or minutes up to hours or days. The other phases of a seizure may include:

• Prodromal phase: When cognitive, mood, or behavioral signs or symptoms may appear
• Aural phase: Characterized by altered sensations or perceptions
• Ictal phase: The actual seizure

The types and severity of symptoms in the postictal phase are largely dependent on the part of the brain involved and how long the seizure lasted. Symptoms can be both mental and physical in nature.

Mental

Postictal symptoms can include awareness, sensory, emotional, or thought changes, such as:

• Exhaustion
  
• Confusion
• Fear and anxiety
  
• Agitation
  
• Frustration
• Shame or embarrassment
• Slow to respond or not able to respond right away
• Memory loss
• Depression/sadness
  

In some cases, people experience more extreme mental symptoms, including:

• Delirium: A change in mental status characterized by significant confusion and disorientation
• Psychosis: A disconnection with reality characterized by hallucinations, delusions, mood changes, and aggression (rare)

On the flip side, some people experience an excessively happy feeling after a seizure called "postictal bliss."

Physical

Physical symptoms of the postictal phase include:

• Headaches or migraines
• Loss of bladder or bowel control
• Thirst
  
• Nausea or upset stomach
• Feeling of weakness/faintness
• Sore muscles
  

As a result of a seizure, a person may also experience injuries ranging from head traumas and bone fractures to bruises and bitten tongues.

Postictal headaches are a common complaint among people with epilepsy. One possible explanation for this is the brain swelling that can result from a seizure.

In some cases, a person may only be aware they've had a seizure when a postictal migraine appears.

Significance

Postictal symptoms can sometimes help healthcare providers determine the focus of the seizure—that is, where in the brain the seizure activity started.

Some examples of this include:

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

Diagnosis

Your healthcare provider will ask you about your symptoms, as well as your medical history and that of your family members.

Various tests help diagnose the type of seizure and its potential causes:

• Neurological exams are often done after a seizure to check mental and motor functioning and to see if there are impairments. This can include asking you to name things or tests of physical movements, strength, and reflexes.
  
• Blood tests may be done to check for various things, including markers of infections or certain genetic conditions that can result in seizures.
• Lumbar puncture (LP), or spinal tap, involves inserting a needle into the lower back to collect a sample of cerebrospinal fluid that surrounds the spinal cord and brain. This fluid can then be tested for infections and conditions that affect the nervous system and can cause seizures.
• Brain imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT scan), can look for abnormalities that can contribute to seizures, such as a brain tumor.
• Electroencephalogram (EEG) involves placing small discs (electrodes) on the scalp to measure electrical activity in the brain. During the postictal phase, an EEG will usually show slowed brain activity on the side of the brain where the seizure originated. However, this result isn't always conclusive.

It may seem that taking an EEG after a seizure has limited value—rather like checking the weather report after a storm has passed. However, the event leaves a trail of altered brain activity that can help doctors characterize seizures so they know how to treat them better in the future.

Coping

Managing and coping with postictal symptoms starts with recognizing what the symptoms are and what is typical for a particular person.

For instance, if your child usually has a postictal migraine, their doctor may be able to prescribe medication that you can give them right after a seizure.

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

Postictal delirium typically goes away quickly. However, some people with severe mental deficits and extensive brain abnormalities may experience delirium that can last for several days after repetitive seizures.

These people require significantly more observation and care.

If you or someone you care for exhibits violent or extremely agitated behavior, seek medical attention. Talk to a healthcare provider about resources and potential medications that may help alleviate aggressive or violent behavior.

Summary

Postictal symptoms vary from person to person and can include sensory, emotional, or thought changes. Physical symptoms can include headaches.

Sometimes the type of symptoms can help your healthcare providers determine where in the brain the activity is occurring and potential causes.

If you are in a position to care for someone in this state, ask them questions about what is typical. When you are familiar with their "normal" course, call their healthcare provider if you have questions or concerns, or if a particular postictal phase seems abnormal for them.

If needed, a physician can also help with long-term strategies.