Postictus

Postictus, or the postictal state, refers to the period after a seizure during which the person experiences impaired consciousness or responsiveness and other neurologic symptoms as the brain recovers. It most commonly follows generalized tonic-clonic seizures but can follow focal seizures with impaired awareness. The duration is variable, ranging from several minutes to hours, and may be longer in children, older adults, or after prolonged seizures.

During the postictal state, individuals may be drowsy or somnolent, confused or disoriented, and amnestic for the seizure. Other common symptoms include slurred speech, headache, nausea, fatigue, and muscle soreness. Transient focal deficits, such as weakness on one side known as Todd’s paralysis, may occur and typically resolve within hours.

Evaluation emphasizes safety and ruling out other causes. Immediate care includes ensuring airway, breathing, and circulation, checking blood glucose, and monitoring vitals. If confusion or focal weakness persists beyond the expected period, or new neurological deficits appear, neuroimaging and electroencephalography (EEG) may be indicated to exclude stroke, hemorrhage, lesions, or ongoing epileptiform activity suggestive of nonconvulsive status epilepticus.

Prognosis is generally favorable, with most symptoms resolving as the brain recovers. Prolonged or unusually severe postictal states can signal factors such as underlying brain injury, medication issues, sleep deprivation, or intoxication. Management is supportive and tailored to the clinical context, with escalation to emergency treatment per local protocols if nonconvulsive status epilepticus is suspected.