Clinical features of the postictal state in adults with epilepsy: A cross‐sectional survey

OBJECTIVE: Persons with epilepsy may experience many postictal symptoms after a seizure, which can significantly impact quality of life. We aimed to determine the frequency, duration, and severity of postictal symptoms to better characterize the postictal period. METHODS: Our cross-sectional questionnaire was adapted from a prior pediatric postictal survey. Face and content validity were evaluated by epilepsy experts and patients from the Calgary Epilepsy Program (CEP). The survey was pilot tested and modified, consisting of 14 physical, cognitive, and psychiatric postictal signs and symptoms. Consecutive CEP adults who had agreed to participate in research and experienced a seizure in the prior 2 years were approached. CEP clinical data were used to supplement survey data. Frequency of factors alleviating and exacerbating postictal symptoms were examined. Spearman's rho was used to explore associations between survey and CEP registry data with statistical significance at ≤ 0.05. RESULTS: Of 351 patients approached, 313 agreed to participate (89%). Fourteen were lost after consent was obtained, and 15 were excluded (incomplete surveys, missing registry data, not having epilepsy). Of the 298 final participants, 54% were female, mean age was 40 years (SD = 15.6), and 95% (282/298) experienced at least one postictal symptom. The three most frequent postictal symptoms were fatigue, sleepiness, or tiredness (84%), confusion or difficulty thinking clearly (75%), and memory problems (69%). For eight of 14 captured postictal symptoms, the most frequently reported symptom duration was <5 min. Mean postictal symptom burden score was correlated with patient reported quality of life and epilepsy-related disability measures. Sleep or rest, medication, and food or drinks were the most common alleviating factors. Lack of rest or sleep, and stress most often exacerbated postictal symptoms. SIGNIFICANCE: This work contributes toward a better understanding of the postictal period and informs the development of future interventions to minimize the impact of the postictal period in epilepsy.