Postictal Seizure State

The postictal state is an abnormal condition that lasts for a period that begins when a seizure subsides and ends when the patient returns to baseline. Marking the termination of a seizure and the return to baseline is straightforward only in a limited number of cases. The difficulty of distinguishing ictal from the postictal period may depend on the type of seizure. It is easier to determine the end of the seizure and the beginning of the postictal state for a generalized tonic-clonic or a generalized tonic seizure. In absence seizures, focal seizures with impaired awareness, and myoclonic seizures, it is harder to distinguish ictal from the postictal state. The practical implication of the postictal state is when it is safe for the patient to return to activity without risking his/her or other's safety. It may also have a localizing value. An ictal speech arrest followed by an immediate postictal return of speech points to nondominant hemisphere seizure onset. A postictal hemiparesis points to contralateral seizure onset.