Postictal status and clinical variables in adults with epilepsy

Agostinho, Cecília Fusco; Tedrus, Glória M. A. S.

doi:10.1055/s-0045-1811625

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Original Article • Arq. Neuro-Psiquiatr. 83 (9) • 2025 • https://doi.org/10.1055/s-0045-1811625 linkcopy

Postictal status and clinical variables in adults with epilepsy

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background Symptoms in the postictal period are often neglected by professionals and patients/family members.

Objective To relate the characteristics of the postictal period with the clinical variables of adult patients with epilepsy.

Methods Prospectively, the clinical characteristics of the postictal period were related to the clinical variables and the scores on the Hospital Anxiety and Depression Scale (HADS) and Mini-Mental State Examination (MMSE) of 70 patients with epilepsy.

Results The mean age was 47.6 years old, and 34 (48.6%) patients were male, the mean age at onset of epilepsy was 20.3 years old, the epileptic syndrome was structural in 48 cases, the mean score in the MMSE was 23.6, the mean score in the HADS-anxiety was 7.3, and in the HADS-depression it was 5.6. Postictal manifestation occurred in 59 (84.2%) cases, with prolonged duration in 22 (37.2%) cases. There was a difference in the duration and presence of postictal manifestation according to age at the onset of epilepsy. Higher HADS-anxiety scores were associated with the presence of confusion in the postictal period (t-test; 9.3 ± 6.8 versus 5.8 ± 4.8; p = 0.015). Lower MMSE scores were related to postictal anxiety and sleepiness/headache/confusion. Left-sided epileptiform activity (EA) was associated with postictal sleepiness/headache/confusion. There was a difference in postictal manifestation according to epileptic syndrome.

Conclusion The characteristics of the postictal period differed according to the age of onset, the type of seizure, and the epileptic syndrome. Different symptoms in the postictal period were associated with the scores on HADS anxiety, MMSE, and left-sided EA on the electroencephalogram.

Keywords
Epilepsy; Seizures; Confusion

		Average, (minimum–maximum) or %
Average age (years old)		47.6 (20–90)
Formal education (years)		9.0 (2–15)
Female gender (n, %)		36 (51.4%)
Mean age at onset of epilepsy (years old)		20.3 (1–77)
Average duration of epilepsy (years)		27.4 (1–78)
Type of seizure: Focal/exclusively generalized (n, %)		52 (74.3%)/18 (25.7%)
Seizure frequency: ≥ 1x/month/1–11x/year/ no seizures in the year		21/22/27
EA laterality: right/left (n, %)		7 (20%)/28 (80%)
No. of ASM in use: 1/≥2 (n, %)		48 (68.6%)/22 (31.4%)
Epileptic syndrome: structural/unknown (n, %)		48 (68.6%)/22 (31.4%)
MMSE total score		23.6 (10–29)
HADS-anxiety (total score)		7.3 (0–19)
HADS-depression (total score)		5.6 (0–20)
Characteristics of the postictal period	Present (n, %)	59 (84.2%)
Characteristics of the postictal period	Duration > 30 minutes	22 (37.2%)
Clinical manifestation	Drowsiness/altered states of consciousness (n, %)	22 (31.4%)
	Headache (n, %)	19 (27.1%)
	Mental confusion (n, %)	30 (42.9%)
	Motor (including aphasia) (n, %)	25 (35.7%)
	Changes in mood and affect (n, %)	25 (35.7%)
	Other (n, %)	38 (54.3%)

		Postictal period		p-value
		No (n = 11)	Yes (n = 59)	p-value
Age (years old)		54.6	46.3	0.071a
Age at onset of epilepsy (years old)		21.5	20.8	0.07a
Duration of epilepsy (years)		33.0	25.5	0.281a
Laterality of the EA on the EEG	Right (n = 7)	3	4	0.01b *
Laterality of the EA on the EEG	Left (n = 28)	1	27	0.01b *
MMSE		25.3 ± 2.7	23.3 ± 3.4	0.047a *
MMSE/schooling	Low score (n = 40)	3	37	0.045b *
MMSE/schooling	Normal score (n = 30)	8	22	0.045b *

Postictal period	Epilepsy variables		p-value
Length of the postictal period	Age at onset of epilepsy
< 30 minutes	23.7 ± 19.6		0.014a *
≥ 30 minutes	14.0 ± 9.5		0.014a *
Headache	Age at onset of epilepsy
Yes	23.7 ± 17.7		0.016a *
No	13.7 ± 13.3		0.016a *
Confusion	HADS-anxiety
Yes	9.3 ± 6.8		0.015a *
No	5.8 ± 4.8		0.015a *
Changes in mood and affect	MMSE - Total score
Yes	24.5 ± 2.5		0.014a *
No	22.4 ± 3.7		0.014a *
Drowsiness/headache/confusion	MMSE - Total score
Yes	23.0 ± 3.6		0.039a *
No	24.6 ± 2.7		0.039a *
Sleepiness/altered states of consciousness	Szs: disperceptive/generalized	Perceptive
Yes	21	1	0.041b *
No	36	12	0.041b *
Headache	Seizures -generalized	Focal
Yes	12	36	0.017b *
No	1	21	0.017b *
Confusion	EEG - Right EA	EA Left
Yes	0	16	0.007b *
No	7	12	0.007b *
Motor manifestation	Structural syndrome	Unknown
Yes	20	5	0.041b *
No	25	20	0.041b *
Changes in mood and affect	MMSE - Low score	Normal score
Yes	13	12	0.045b *
No	9	25	0.045b *
Drowsiness/headache/confusion	ELT-EH	Other epilepsies
Yes	13	5	0.038b *
No	11	16	0.038b *
Drowsiness/headache/confusion	EEG - Right EA	EEG - Left EA
Yes	2	20	0.036b *
No	5	8	0.036b *

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[TFN1] Abbreviations: ASM, anti-seizure medication; EA, epileptiform activity; HADS, Hospital Anxiety and Depression Scale; MMSE, Mini-Mental State Examination.