Signs and symptoms of the postictal period in epilepsy: A systematic review and meta-analysis

Subota, Ann; Khan, Samiya; Josephson, Colin B.; Manji, Sofiya; Lukmanji, Sara; Roach, Pamela; Wiebe, Samuel; Buchhalter, Jeffrey; Federico, Paolo; Teskey, G. Campbell; Lorenzetti, Diane; Jetté, Nathalie

doi:10.1016/j.yebeh.2019.03.014

Cited by 36 publications

(53 citation statements)

References 46 publications

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“…In the post-ictal period motor weakness, termed Todd's paresis can occur for variable periods of time, and may be related to ongoing inhibition [48,49]. It is reported in < 1% of LTM series, yet is a strong lateralising sign, indicating onset in the contralateral hemisphere in 93% of patients who experience it [50].…”

Section: Neurobiological Basis Of Testingmentioning

confidence: 99%

“…Postictal aphasia almost always indicates dominant hemisphere involvement, seen in 12% of cases of temporal lobe epilepsy [66]. The maximal duration of postictal dysphasia is not clear from published cases [49], but language recovery is related to presence of a structural etiology and hemisphere of onset [67,68]. One [74].…”

Section: Ictal and Postictal Motor Testingmentioning

confidence: 99%

“…Visual field loss can co-exist with positive hallucinations seen within the field defect [81]. Visual field loss or bilateral blindness (amaurosis) can also be seen as a postictal feature, lasting minutes to days [49]. Complex visual hallucinations are seen with seizures involving the visual association cortex [82], including medial (limbic), lateral temporal, posterior parietal cortex, and the temporo-parietaloccipital junction [83].…”

Section: Neurobiological Basis Of Testingmentioning

confidence: 99%

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Structured testing during seizures: A practical guide for assessing and interpreting ictal and postictal signs during video EEG long term monitoring

Kinney

Kovač

Diehl

2019

Seizure

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Background: Ictal and postictal testing carried out in long-term epilepsy monitoring units is often sub-optimal. Recently, a European consensus protocol for testing patients during and after seizures was developed by a joint taskforce of the International League Against Epilepsy-Commission on European Affairs and the European Epilepsy Monitoring Unit Association. Aim: Using this recently developed standardised assessment battery as a framework, the goal of this narrative review is to outline the proposed testing procedure in detail and explain the rationale for each individual component, focusing on the underlying neurobiology. This is intended to serve as an educational resource for staff working in epilepsy monitoring units. Methods: A literature review of PubMed was performed; using the search terms "seizure", "ictal", "postictal", "testing", "examination", and "interview". Relevant literature was reviewed and relevant references were chosen. The work is presented as a narrative review. Results: The proposed standardised assessment battery provides a comprehensive and user-friendly format for ictal-postictal testing, and examines consciousness, language, motor, sensory, and visual function. Conclusion: The standardised approach proposed has the potential to make full use of data recorded during video EEG increasing the diagnostic yield with regards to lateralisation and localisation, aiding both presurgical and diagnostic studies.

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Section: Neurobiological Basis Of Testingmentioning

confidence: 99%

Section: Ictal and Postictal Motor Testingmentioning

confidence: 99%

Section: Neurobiological Basis Of Testingmentioning

confidence: 99%

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Structured testing during seizures: A practical guide for assessing and interpreting ictal and postictal signs during video EEG long term monitoring

Kinney

Kovač

Diehl

2019

Seizure

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“…The postictal state is largely an overlooked aspect of epilepsy (Khan et al, 2018;Subota et al, 2018) that is defined by brain region specific impairments, ranging from amnesia to weakness (MacEachern et al, 2017), results in reduced quality of life (Josephson et al, 2016) and is currently untreated. Local arterioles in those areas of the brain involved in seizure activity become constricted leading to hypoperfusion (Farrell et al, 2016;Gaxiola-Valdez et al, 2017) and have oxygen levels, fall from the normoxic range (pO2 = 18-30mmHg) to below the critical severe hypoxic threshold of (pO2 = 10mmHg) for more than an hour (Farrell et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Caffeine Exacerbates Postictal Hypoxia

et al. 2019

Self Cite

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Background: Postictal hypoxia (PIH) is a stroke-like event that follows seizures and may be responsible for the postictal state. PIH may also be a contributing factor to the development of seizure-induced brain abnormalities and behavioral dysfunction associated with epilepsy. Caffeine is the world's most popular drug with ~85% of people in the US consuming it daily. Thus, persons with epilepsy are likely to have caffeine in their system during seizures. This preclinical study investigated the acute and chronic effects of caffeine on tissue oxygenation pre and post seizure. Methods: We utilized the electrical kindling model in rats. A stimulating/recording electrode was placed into the rat ventral hippocampus (CA3), and an oxygen measuring optrode in dorsal hippocampus (CA1). Rats were administered vehicle (saline) or caffeine (5.0, 10.0, or 15.0 mg/kg) intraperitoneally, 30 minutes prior to an elicited seizure. Hippocampal oxygen levels were continually measured post-injection, and post-seizure, until returning to the normoxic range. Further, rats were administered various agonists and antagonists to determine adenosine receptors role in PIH. Lastly, rats were administered a chronic regime of caffeine to determine the long-term effects of caffeine in relation to PIH. Results: Caffeine at high (15. 0mg/kg) doses, caused a significant drop in pre-seizure hippocampal pO2. Following a seizure, caffeine at 10.0mg/kg and 15.0mg/kg, increased the time below the severe hypoxic threshold (10mmHg). Caffeine's metabolites, paraxanthine, theobromine, and theophylline also increased the time below the severe hypoxic threshold. Adenosine A1 receptor agonist n6-Cyclopentyladenosine caused a significant drop in pre-seizure mean pO2 and increased the area below severe hypoxic threshold. A2A receptor antagonist SCH-Table of Contents

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“…For example, population-based studies have estimated the lifetime prevalence of epilepsy at 1.2% of all adults in England [6], and a three-fold increased risk of schizophrenia-like psychosis was found in patients with epilepsy (PWE) in Denmark [7]. In a systematic review, PIP had a frequency of 4% among all reported postictal manifestations in PWE [8]. An almost eight-fold risk of psychosis in PWE was found in another systematic review, with a pooled estimate of the prevalence of psychosis in epilepsy at 5.6% (temporal lobe epilepsy psychosis at 7%, interictal psychosis at 5.2%, postictal psychosis at 2%) [9].…”

Section: Introductionmentioning

confidence: 99%

"You Are The One Who Was Beating Me": A Case Report of a Patient with Postictal Psychosis Secondary to Bilateral Temporal Lobe Epilepsy

Ngo¹,

Camacho

Singh

2019

Cureus

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Postictal psychosis is a rare but potentially serious complication in patients with seizure disorders. There is no consensus on best practices in managing and treating postictal psychosis as well as other psychoses of epilepsy, but current research is investigating topics such as adherence to seizure medications and antipsychotic administration during or before psychosis and addressing psychosocial stressors as potential components of effective treatment. We present a case report detailing a patient's lengthy history of postictal psychosis due to her underlying temporal lobe epilepsy; her disease course as correlated by a diagnostic electroencephalogram (EEG), her history of medication nonadherence, and the treatment of postictal psychosis are also discussed.

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Signs and symptoms of the postictal period in epilepsy: A systematic review and meta-analysis

Cited by 36 publications

References 46 publications

Structured testing during seizures: A practical guide for assessing and interpreting ictal and postictal signs during video EEG long term monitoring

Structured testing during seizures: A practical guide for assessing and interpreting ictal and postictal signs during video EEG long term monitoring

Caffeine Exacerbates Postictal Hypoxia

"You Are The One Who Was Beating Me": A Case Report of a Patient with Postictal Psychosis Secondary to Bilateral Temporal Lobe Epilepsy

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