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SEIZURES: ICTAL AND
POST-ICTAL STATES |
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The clinical picture of a seizure can be divided into the
ictal and post-ictal
states. The ictal state is the actual seizure
(i.e., the hyperexcitation of a group of neurons that may or may not spread to
involve adjacent gray matter and/or the entire cerebral cortex).
The post-ictal state occurs after the seizure.
It is the recovery phase following the actual seizure. It occurs from the the
high metabolic requirements of the actual seizure resulting in a subsequent
period of neuronal hypofunction. Thus, symptoms and signs during the ictal state
are positive (or excitatory) whereas the symptoms and signs during the
post-ictal state are negative (or lack of function).
In most cases, differentiating the ictal from the post-ictal state is
straightforward. However, in some seizure types, especially complex partial, it
can be difficult.
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Seizure Type |
Ictal
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Post-ictal |
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Partial motor |
Clonic twitching; head and eye
deviation away from the focus; no loss of consciousness
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Decreased tone; weakness of the limb
or side (i.e., Todd's paralysis) |
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Partial sensory |
Paresthesias; no loss of consciousness
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Hypesthesia |
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Other Simple Partial |
Autonomic, gustatory, or olfactory phenomena, depending on the cortical region affected
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Often minimal or difficult to detect |
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Complex Partial |
Automatisms, altered responsiveness
and awareness to the environment |
Change in personality, change in
behavior, depressed level of alertness, memory impairment
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Partial with Secondary Generalization |
Focal motor, sensor, autonomic, gustatory, olfactory, autonomic
or behavioral disturbance, followed by loss of consciousness, tonic
stiffening and clonic twitching often associated with tongue biting, opisthotonos, cry or moan
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Decreased tone and weakness [worst on
the side where the partial seizure started (i.e., Todd's paralysis)],
urinary incontinence, depressed level of alertness, memory
impairment |
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Generalized Tonic Clonic |
Loss of consciousness, tonic
stiffening following by clonic twitching, tongue biting,
opisthotonos, cry or moan |
Loss of muscle tone, diffuse weakness,
urinary incontinence, depressed level of alertness, memory
impairment
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Absence |
Brief loss of consciousness (5-10 sec)
and subtle motor manifestations, such as eye blinking or a slight
head turning |
Often minimal |
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