A Scoping Review of the Postictal State
Abstract number :
2.021
Submission category :
11. Behavior/Neuropsychology/Language / 11A. Adult
Year :
2024
Submission ID :
599
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Rachel Eisenbarth, MD – University of Southern California
Cindy Wong, DO – University of Southern California
Charles Liu, MD, PhD – Keck School of Medicine, University of Southern California
Ryan McGinn, MD – University of Southern California
Rationale: The postictal state can be defined as the transient period following a seizure characterized by a range of physical, cognitive, autonomic, and/or emotional changes. Lateralization/localization of seizures has been described with such phenomena as post-ictal nose wiping, hemiparesis, and aphasia, and systematic reviews have helped understand the epidemiology of common features. To our knowledge, this is the first scoping review of the postictal state. We do so here to understand the breadth of postictal findings reported to date.
Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Embase from inception to January 21, 2024. The search strategy included terms related to (Postictal) AND (Epilepsy OR Seizures) AND (Examination OR Assessment OR various clinical terms including emotional, cognitive and other neurological findings). Inclusion criteria comprised of 1) human patients, 2) the availability of patient-level data, and 3) a description of subjective or objective signs/symptoms in the immediate postictal state, including vital signs and EKG. Exclusion criteria consisted of 1) non-human data, 2) investigation data only (such as MRI), and signs/symptoms beginning in the pre-ictal or ictal state. Article inclusions/exclusions were performed independently by RE and CW with discrepancies resolved by RM.
Results: After the removal of duplicates, 6239 articles were screened. 5392 were excluded in the title/abstract review, and 838 were excluded in full-text review, leaving 525 for data extraction. Data was available for a total of 47,683 patients and at least 8,734 separate instances of postictal findings. Our search revealed at least 122 discrete postictal findings. The most frequent focal neurological signs/symptoms were aphasia/dysphasia (781 instances), hemiparesis (766), nose rubbing (522), face wiping (492), memory deficits (423), oral or manual automatisms (168), and hemianopia (19). There were frequent reports of postictal headaches (2536) as well as psychiatric disorders including postictal psychosis/delirium (1019), mania (11), and other mood changes (483). We also encountered reporting of vital sign changes such as autonomic instability (352), arrhythmias (88), and respiratory dysfunction (214). There were also rarely reported cortical signs and other phenomena including dyscalculia (3), astereognosia (1), agraphesthesia (2), dysprosody (1), palinacousis (7), gaze palsies (31), Kluver-Bucy syndrome (13) and cortical blindness (15), among others. In total, 61.4% of postictal findings had either lateralization or localization information.
Conclusions: As has been shown in previous systematic reviews, aphasia, headaches, hemiparesis, and psychosis are commonly described postictal features. We show that beyond this, there is a richness of clinical data in the postictal state that may be underappreciated. The future development of more detailed post-ictal assessments, automated or otherwise, may result in improved epilepsy assessments and possibly improve non-invasive localization of seizures.
Funding: None
Behavior