Abstract Objective Postictal deficits are a well‐recognized phenomenon, yet their mechanisms and predictors remain poorly understood. Distinguishing postictal deficits from recurring nonconvulsive seizures (NCSz) or nonconvulsive status epilepticus (NCSE), their main differential diagnosis, can be challenging. This study aimed to identify clinical and electrographic features predictive of ongoing or recurrent ictal activity and to explore biomarkers associated with the duration and severity of postictal deficits. Methods We conducted a retrospective case–control study of patients with prolonged (>1 h) postictal deficits at a tertiary medical center between 2017 and 2022. Based on electroencephalographic (EEG) findings, patients were classified as having uncomplicated Todd's palsy or recurring NCSz. Clinical, imaging, and electrographic characteristics were compared between groups, and factors associated with postictal duration were analyzed. Results Among 112 patients, 86 (77%) had uncomplicated Todd's palsy and 26 (23%) had recurring NCSz. Patients with NCSz were younger (63 vs. 76 years, p = .022) and had longer deficits (2.5 vs. 1.5 days, p = .024). Sporadic epileptiform discharges (73% vs. 22%, p 1—by extended continuous EEG monitoring.
Kermorvant et al. (Mon,) studied this question.