Outlook: the postictal state--future directions for research.

Future directions for research need to include studies of the various experimental and clinical aspects of the postictal state. More specifically, we need reliable and validated instruments that are able to measure the beginning and the end of the postictal period. Although a number of questionnaires are available, we currently have no evidence that these tests are able to assess drug effects on the postictal state, if they exist. In addition to the need for sensitive, reproducible and objective measures of the postictal state, we need instruments to differentiate the specific effects of AEDs or non-pharmacological therapy on the postictal state from indirect effects because of overall reduction in seizure severity. Although it would be naïve to think that the mechanisms of seizure termination are necessarily less complex than those involved in ictal onset, it is certainly worthwhile to explore strategies for the development of a new class of drugs for seizure control that work primarily through mechanisms involved in seizure termination and postictal refractoriness.