Nattsumi's Epilepsy Diary

Postictal Sleep

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Postictal sleep is a common phenomenon after a generalized tonic-clonic seizure. The patient may pass through several stages from sleep to delirium to drowsiness before awakening. During the late postictal state, the heart rate begins to normalize from the typical ictal tachycardia. There is a decrease in muscle tone with bladder sphincter relaxation and incontinence that typically occurs in the early postictal phase. In the immediate postictal phase, there is partial obstruction of the airway resulting in stertorous respirations. Deep tendon reflexes are diminished and the plantar responses are sometimes extensor. The patient then may pass into sleep. If the seizure occurs during the night, the patient may sleep through the postictal period and awaken with complaints of tongue soreness, muscle aches, or nocturnal enuresis. Patients may often experience postictal morning headaches or unexplained bruises.

Although postictal sleep is a frequent occurrence after a generalized tonic-clonic seizure, it may also occur after complex partial seizures. The characteristics of postictal sleep have not been well studied. Some authors differentiate between sleep that occurs after a seizure and results from a compulsory need to sleep after a complete recovery of consciousness, and sleep in which the postictal events move directly from a period of confusion to sleep without ever a complete recovery to baseline (Tassinari et al., 1987). Whether these two manifestations of postictal sleep differ in their electrographic correlates or pathophys-