Ann Subota1, Sundus Khan2, Colin B Josephson3, Sofiya Manji4, Sara Lukmanji5, Pamela Roach6, Samuel Wiebe3, Jeffrey Buchhalter7, Paolo Federico5, G Campbell Teskey8, Diane L Lorenzetti9, Nathalie Jetté10. 1. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada. 2. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada. 3. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; O'Brien Institute of Public Health, University of Calgary, 3rd Floor TRW Building 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada. 4. Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada. 5. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada. 6. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada. 7. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; The Alberta Children's Hospital Research Institute, Calgary, 293 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada. 8. Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Cell Biology and Anatomy, University of Calgary, HMRB 212 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada. 9. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Health Sciences Library, University of Calgary, 1450 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada. 10. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Icahn School of Medicine at Mount Sinai, Department of Neurology, One Gustave L. Levy Place, Box 1137, New York, NY 10029, USA; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, Room 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada. Electronic address: nathalie.jette@mssm.edu.
Abstract
OBJECTIVE: The postictal period has many physical, behavioral, and cognitive manifestations associated with it. These signs and symptoms are common, can be quite debilitating, and can have a continued impact long after the seizure has ended. The purpose of this systematic review was to quantify the occurrence of postictal signs and symptoms, along with their frequency and duration in persons with epilepsy. METHODS: Cochrane Database of Systematic Reviews, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, and Scopus were searched from inception to November 29, 2017. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards were followed. Search terms included subject headings and text words such as convulsion, epilepsy, seizure, postictal, post seizure, seizure recovery, seizure end, Todd's paresis, and Todd's paralysis. Standardized forms were used to collect various study variables. Abstract and full-text review, data abstraction, and quality assessment were all done in duplicate. Study heterogeneity was assessed using the I-squared test, and a random effects model was used to determine estimates. Publication bias was evaluated using funnel plots. RESULTS: From 7811 abstracts reviewed, 78 articles met eligibility criteria, with 31 postictal manifestations (signs and/or symptoms) described and 45 studies included in the meta-analysis. The majority of studies described postictal headaches, migraines, and psychoses, with mean weighted frequency of 33.0% [95% confidence interval (CI) 26.0-40.0], 16.0% [95% CI 10.0-22.0], and 4.0% [95% CI 2.0-5.0], respectively. The mean weighted proportions of manifestations ranged from 0.5% (subacute postictal aggression) to 96.2% (postictal unresponsiveness) with symptom duration usually lasting <24 h but up to 2 months for physical and cognitive/behavioral symptoms respectively. SIGNIFICANCE: Examining data on the various signs and symptoms of the postictal period will have practical applications for physicians by raising their awareness about these manifestations and informing them about the importance of optimizing their prevention and treatment in epilepsy.
OBJECTIVE: The postictal period has many physical, behavioral, and cognitive manifestations associated with it. These signs and symptoms are common, can be quite debilitating, and can have a continued impact long after the seizure has ended. The purpose of this systematic review was to quantify the occurrence of postictal signs and symptoms, along with their frequency and duration in persons with epilepsy. METHODS: Cochrane Database of Systematic Reviews, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, and Scopus were searched from inception to November 29, 2017. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards were followed. Search terms included subject headings and text words such as convulsion, epilepsy, seizure, postictal, post seizure, seizure recovery, seizure end, Todd's paresis, and Todd's paralysis. Standardized forms were used to collect various study variables. Abstract and full-text review, data abstraction, and quality assessment were all done in duplicate. Study heterogeneity was assessed using the I-squared test, and a random effects model was used to determine estimates. Publication bias was evaluated using funnel plots. RESULTS: From 7811 abstracts reviewed, 78 articles met eligibility criteria, with 31 postictal manifestations (signs and/or symptoms) described and 45 studies included in the meta-analysis. The majority of studies described postictal headaches, migraines, and psychoses, with mean weighted frequency of 33.0% [95% confidence interval (CI) 26.0-40.0], 16.0% [95% CI 10.0-22.0], and 4.0% [95% CI 2.0-5.0], respectively. The mean weighted proportions of manifestations ranged from 0.5% (subacute postictal aggression) to 96.2% (postictal unresponsiveness) with symptom duration usually lasting <24 h but up to 2 months for physical and cognitive/behavioral symptoms respectively. SIGNIFICANCE: Examining data on the various signs and symptoms of the postictal period will have practical applications for physicians by raising their awareness about these manifestations and informing them about the importance of optimizing their prevention and treatment in epilepsy.
Authors: Prisca R Bauer; Else A Tolner; Mark R Keezer; Michel D Ferrari; Josemir W Sander Journal: Nat Rev Neurol Date: 2021-07-26 Impact factor: 42.937
Authors: Julia C M Pottkämper; Joey P A J Verdijk; Jeannette Hofmeijer; Jeroen A van Waarde; Michel J A M van Putten Journal: Epilepsia Open Date: 2021-08-20