Postictal affective episodes

Despite their recognition two centuries ago, postictal depression symptoms (PDSs) and episodes (PDEs) continue to be ignored by most clinicians in their evaluation of patients with epilepsy. And yet, PDSs are relatively frequent in patients with pharmacoresistant epilepsy, having been identified in almost 50% of patients with a median duration of 24 hours. PDSs may be the expression of symptoms restricted to the postictal period (defined as the first 5 days following a seizure) and/or may be the expression of postictal exacerbation in severity of interictal symptoms of depression. In fact, a past history of depressive and anxiety disorders has been associated with the occurrence of PDSs and PSEs. PDSs and PSEs often occur together with postictal symptoms of anxiety, and the occurrence of PDSs has been associated with more severe postictal cognitive deficits. The occurrence of PDSs and PDEs has not been associated with any epilepsy-related variable (location of seizure focus, MRI findings, type of antiepileptic drug). Prevention of PDSs and PDEs can be achieved only with seizure freedom, and preliminary uncontrolled data suggest that being on antidepressant medication does not protect patients from experiencing these types of symptoms.