Postiktala

Postiktala, also known as the postictal state, is the period after a seizure during which a person’s cognitive and physical functions gradually recover from ictal activity. It commonly follows generalized seizures but can occur after focal seizures as well.

Symptoms during the postictal phase may include confusion or drowsiness, slowed or incoherent speech, impaired memory for the seizure event, headaches, dizziness, nausea, and, in some cases, transient weakness on one side of the body known as Todd’s paralysis. The duration is variable, typically minutes to hours, and can be longer in children or after complex seizures.

The underlying pathophysiology involves neuronal exhaustion from excessive firing, metabolic shifts (such as changes in glucose utilization and lactate production), altered cerebral blood flow, and neurotransmitter system adjustments. These processes contribute to altered consciousness and sensorimotor or cognitive symptoms as the brain returns to baseline activity.

Clinical management emphasizes safety and supportive care. Before and during recovery, ensure the person’s airway, breathing, and circulation are stable, protect them from injury, and minimize stimulation. Reorientation and a calm environment aid recovery. If confusion persists or there is concern for ongoing seizure or non-convulsive status epilepticus, medical evaluation is warranted, including possible EEG and treatment decisions by clinicians.

Prognosis is generally favorable, with most individuals regaining full function within hours. Prolonged postictal states or recurrent postictal abnormalities may indicate inadequate seizure control, underlying brain pathology, or new neurological problems and require medical assessment.