Postictal state
The postictal state is the
, and other disorienting symptoms.The
- Ictal period refers to a physiologic state or event such as a seizure, stroke, or headache. The word originates from the Latin word ictus, meaning a blow or a stroke. In electroencephalography (EEG), the recording during a seizure is said to be "ictal". The following definitions refer to the temporal relation with seizures.[1]
- Pre-ictal refers to the state immediately before the actual seizure, stroke, or headache.
- Post-ictal refers to the state shortly after the event.
- Interictal refers to the period between seizures, or subclinical seizures. Interictal EEG discharges are those abnormal waveforms not associated with seizure symptoms.
Signs and symptoms
Postictal migraine headaches are a major complaint among persons with
Other symptoms associated with the postictal state are less common.
Postictal psychosis is a neuropsychiatric sequel to seizures of chronic epilepsy in adults. Tending to occur with bilateral seizure types it is characterized by auditory and visual
Postictal bliss or euphoria is also reported following seizures. This has been described as a highly blissful feeling associated with the emergence from amnesia. Feelings of depression before a seizure may lead to postictal euphoria.[5]
Some of postictal symptoms are almost always present for a period of a few hours up to a day or two.
The postictal state can also be useful for determining the focus of the seizure. Decreased verbal memory (short term) tends to result from a seizure in the dominant hemisphere, whereas seizures in the non-dominant hemisphere tend to manifest with decreased visual memory. Inability to read suggests seizure foci in the language areas of the left hemisphere, and "after a seizure semivoluntary events as mundane as nose wiping tend to be done with the hand ipsilateral to [that is, on the same side as,] the seizure focus."[3]
Mechanism
While it might seem that the neurons become “exhausted” after the near-constant firing involved in a seizure, the ability of the neuron to carry an action potential following a seizure is not decreased. Neurons of the brain fire normally when stimulated, even after long periods of status epilepticus.[3]
Neurotransmitters
Neurotransmitters must be present in the axon terminal and then exocytosed into the synaptic cleft in order to propagate the signal to the next neuron. While neurotransmitters are not typically a limiting factor in neuronal signaling rates, it is possible that with extensive firing during seizures neurotransmitters could be used up faster than new ones could be synthesized in the cell and transported down the axon. There is currently no direct evidence for neurotransmitter depletion following seizures.[3]
Receptor concentration
In studies that stimulate seizures by subjecting rats to
Active inhibition
It is possible that seizures cease spontaneously, but it is much more probable that some changes in the brain create inhibitory signals that serve to tamp down the overactive neurons and effectively end the seizure. Opioid peptides have been shown to be involved in the postictal state and are at times anticonvulsive, and adenosine has also been implicated as a molecule potentially involved in terminating seizures. Evidence for the theory of active inhibition lies in the postictal refractory period, a period of weeks or even months following a series of seizures in which seizures cannot be induced (using animal models and a technique called kindling, in which seizures are induced with repeated electrical stimulation).[2]
Leftover inhibitory signals are the most likely explanation for why there would be a period in which the threshold for provoking a second seizure is high, and lowered excitability may also explain some of the postictal symptoms. Inhibitory signals could be through
While not an example of active inhibition,
Cerebral bloodflow
Cerebral
See also
References
- PMID 21447894. Archived from the originalon 18 June 2015. Retrieved 22 July 2021.
- ^ .
- ^ S2CID 20393636. Archived from the originalon 2 June 2018. Retrieved 22 July 2021.
- PMID 18330462.
- ^ Engel 2013, p. 332, Chapter 9: Periictal PhenomenaQuote: "Patients who are aware of increased depression or tension prior to generalized tonic-clonic or limbic seizures occasionally report a feeling of euphoria or release during the postictal period[...] [P]atients with interictal or preictal depression can report relief or euphoria postictally, which is consistent with the well-known beneficial effect of electroconvulsive shock therapy (ECT). Postictal hypomania can occur, particularly after repeated limbic seizures."
- PMID 20821849. Archived from the original on 21 January 2011. Retrieved 22 July 2021 – via NCBI (National Center for Biotechnology Information)/NLM (United States National Library of Medicine).
Absence ... seizures begin and end suddenly. There is no warning before the seizure, and immediately afterward the person is alert and attentive. This lack of a postictal period is a key feature that allows one to distinguish between absence and partial complex seizures.
- PMID 17301080. Archived from the originalon 2 June 2018. Retrieved 22 July 2021.
- PMID 9098212. Retrieved 22 July 2021.