Weakness and focal sensory deficits in the postictal state

Postictal motor deficits may occur in patients following partial and generalized tonic-clonic seizures. Frequency is unclear, epidemiology being hampered by heterogeneous populations and variable methods of detection. Postictal paresis may affect any body part, may be bilateral, and may occur more frequently in seizures involving the sensorimotor cortex. Duration varies depending on the precise mode of testing from a few minutes to 36 hours. Sensory deficits following seizures have been rarely reported but may be missed if not specifically tested for. The lateralizing value of postical paresis is high (>90%), pointing to a seizure origin in the opposite frontal lobe. Postictal paresis often is lesion associated and should encourage MRI, particularly in new-onset epilepsy. Etiology is unclear, neuronal exhaustion and hyperinhibition being the main pathophysiological theories discussed. As disability from seizures may be increased, postictal paresis should more systematically be asked and tested for and should also be included when evaluating the success of anticonvulsive treatment.