The Postictal Phase of a Seizure

The postictal phase refers to the period of time immediately following a seizure. The postictal phase can last for seconds, minutes, hours, and sometimes even days. It is commonly thought of as the time during which the brain recovers from a seizure.

The other phases include the prodromal phase (when cognitive, mood, or behavioral signs or symptoms may appear), the aural phase (characterized by altered sensations or perceptions), and the ictal phase (the actual seizure).

The types and severity of symptoms are largely dependent on the part of the brain involved and how long the seizure lasted.

Postictal symptoms can effect changes in behavior, thinking, mood, and motor function, including:

As a result of a seizure, a person may experience injuries ranging from head traumas and bone fractures to bruises and bitten tongues. There may also be an emotional component characterized by feelings of embarrassment, anxiety, frustration, sadness, agitation, and confusion.

In some cases, people experience more extreme mental symptoms, including delirium and psychosis.

Postictal migraines are a common complaint among people with epilepsy. One possible explanation for this is the cerebral edema (brain swelling) that can result from a seizure, causing increased intracranial pressure and pain.

On the flip side, some people have postictal bliss, described as an excessively happy feeling, after a seizure.

Postictal symptoms can sometimes help doctors determine the focus of the seizure—that is, where in the brain the seizure activity started.

Some examples of this include:

• Postictal dysphasia: Characterized by difficulty speaking, this suggests the seizure originated in your dominant hemisphere. In a right-handed person, that would be the left half of the brain.
• Postictal paralysis: Temporary weakness of a hand or limb is associated with the side of the body opposite from the seizure focus in the brain.
• Postictal automatisms: Repetitive actions such as lip-smacking and nose rubbing are a common sign of complex partial seizures, which frequently arise in the temporal lobe.

During the postictal phase, an electroencephalogram (EEG) will usually show slowed brain activity on the side of the brain where the seizure originated.

Sometimes, though, the slower activity occurs in both the ictal and postictal phases, making it difficult to distinguish between the phases on EEG. In addition, the brain-wave changes on an EEG do not always correlate with a person's behavioral changes.

For those reasons, some doctors prefer to focus on describing a person's behavior in context with any EEG changes that occur during or after a seizure as opposed to labeling them ictal or postictal.

While it may seem that taking an EEG after a seizure has limited value—rather like checking the weather report after a storm has passed—the event leaves a trail of altered brain activity that can help doctors characterize seizures so they know better how to treat them in the future.

Managing and coping with postictal symptoms starts with recognizing what the symptoms are and what is typical for a particular person. For instance, if your child usually has a postictal migraine, their doctor may be able to prescribe medication that you can give them right after a seizure.

Taking care of physical needs (such as thirst), a safe and calm environment, rest, reassurance, and emotional support can all help as well.

In people who experience postictal delirium, a global change in overall brain functioning, it typically goes away quickly. However, those with severe seizures may experience longer periods (lasting a few hours to days) that require significantly more care.

Some people with severe mental deficits and extensive brain abnormalities may experience delirium that can last for several days after repetitive seizures. These people typically already require significant observation and care.

If you or someone you care for exhibits violent or extremely agitated behavior, talk to a doctor about medications that may help prevent this. Otherwise, creating a safe environment, tending to physical needs, and providing emotional comfort are usually sufficient for getting through delirium.

Postictal psychosis is characterized by hallucinations, delusions, mood changes, and aggression. These episodes are rare; a 2016 study found that just 3.7 percent of people with epilepsy experience them.

If you suspect postictal psychosis in yourself or someone else, contact a doctor about how it can be treated and managed, and be aware of suicide warning signs.

If you could be in a position to care for someone in this state, ask them questions about what is typical. When you are familiar with the "normal" course of things, make sure to call the doctor if you have questions or concerns, or if a particular postictal phase seems abnormal. If needed, a physician can also help with long-term strategies.