Postictal State

What is the postictal state of a seizure?

The postictal state is a temporary brain condition that happens when a seizure ends and before you feel like yourself again. It’s a group of symptoms that affect your behavior, thoughts, feelings and ability to function as expected.

Imagine an athlete who just finished running in a race. They’re tired after pushing their body to reach the finish line. After the race, they may cool down by stretching, rehydrating and resting. This cool-down period is the postictal state.

During a seizure, your neurons (nerve cells) create a burst of electrical activity in your brain. Now, they’re exhausted and trying to recover. During your brain’s recovery, you may feel confused, have a headache or have trouble remembering things. You may need to spend the day in bed resting and avoiding activities requiring a lot of brain power or physical exertion.

The postictal state could last for a few minutes to a few days. Each person’s experience in the postictal state is different.

How common is the postictal state?

The majority of people who experience a seizure notice postictal state symptoms. The condition is temporary.

What are the symptoms of the postictal state of a seizure?

The symptoms of the postictal state of a seizure most commonly may include:

• Headache or migraine.
• Confusion.
• Fatigue or exhaustion.
• Memory loss.
• Depression and/or anxiety.
• Soreness or muscle weakness.
• Mood or emotional changes (agitation, shame or embarrassment).
• Difficulty speaking.

Symptoms vary based on where the abnormal electrical activity happened in your brain or how long the seizure lasts. Severe seizures may cause:

• A loss of consciousness or coma.
• Delirium.
• Hallucinations.
• Psychosis.

You might also experience the following in the postictal state:

• An abnormal heartbeat.
• Coughing.
• High body temperature.
• Low or high blood pressure.
• Loss of bladder or bowel control.
• Nausea.

If you regularly have seizures and notice symptoms that seem different from what you’re used to, contact your healthcare provider.

What are the complications of the postictal state?

Seizures can have a significant impact on your mental health. You may feel nervous and fearful that another seizure will happen. You may isolate yourself from others if you have a seizure in a public place where other people are watching you. These thoughts and feelings may be overwhelming while in the postictal state. You may notice symptoms of depression and anxiety lingering even after you’ve completely recovered.

A mental health professional can help you manage the effects of seizures on your mental health and emotional well-being.

In some cases, you may experience suicidal thoughts (suicidal ideation). If you find yourself feeling this way and need someone to talk to, reach out to the Suicide & Crisis Lifeline by calling or texting 988. Someone is available 24/7 to help you if you’re in a rough spot.

How is the postictal state diagnosed?

Healthcare providers usually don’t make a formal postictal state diagnosis, especially if you have a history of seizures. The signs and symptoms you experience indicate that you’re in the postictal state.

In some cases, the presence of postictal state symptoms may help your provider diagnose a seizure if it happened outside of a healthcare facility for the first time. If this is the case, a healthcare provider may order tests to confirm, like:

• Blood tests.
• EEG.
• MRI.
• PET scan.
• Lumbar puncture.

How is the postictal state treated?

There isn’t a specific treatment available for the postictal state. Supportive care, like reassurance that you’re safe, resting and taking an over-the-counter pain reliever (as directed) for a headache, may be all that you need.

Symptoms usually go away on their own within a day after a seizure. However, it’s important to update your provider that a seizure occurred because they may want to make changes to your treatment.

In some cases, your healthcare provider may recommend antiseizure medications, triptans or psychotropic medications (like antidepressants) depending on the frequency of seizures and how severe postictal state symptoms are.

Your provider may offer sedatives and supportive care in a clinical setting if you experience psychosis symptoms.

How long does the postictal state last?

The postictal state can last anywhere from minutes to days. On average, it lasts between five and 30 minutes. The timeframe varies from person to person and seizure to seizure. When this phase of a seizure is over, you’ll start feeling more like yourself. If symptoms last longer than 24 hours, contact your healthcare provider.

Do all seizures have a postictal state?

No. Not everyone who experiences a seizure will go through the postictal state. Each seizure is different, and so is the way it affects you.

When should I see a healthcare provider?

Visit your healthcare provider if the postictal state lasts longer than a day after a seizure.

Contact emergency services if you:

• Have a seizure for the first time.
• Regularly have seizures and the symptoms you feel are different or severe.

What questions should I ask my healthcare provider?

• What can I do at home to manage postictal state symptoms?
• Can I take over-the-counter pain relievers safely?
• Can we discuss treatment options to prevent future seizures?
• What do I do if symptoms last longer than a day?
• Is it safe to go back to work or school after a seizure?
• When should I follow up with you and when should I call the office?