Effects of anti-seizure medications on postictal state of epilepsy_Journal of Epilepsy

Authors：

CAO Lanlan , CHEN Yue ,  TAO Lihong

1. Department of Neurdogy, Affiliated Hospital of Yangzhou Universit, Yangzhou 225000, China;

Corresponding author：

TAO Lihong, Email: 2446432746@qq.com

Keywords：

Epilepsy; Postictal state; Postictal symptoms; Antiseizure medications; Treatment

DOI：

10.7507/2096-0247.202401006

Video：

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The postictal state which describes changes in behavior, motor function, and neuropsychological performance that occur after a seizure and persist until these variables return to their normal baseline, which can take anywhere from a few seconds to a few hours to a few days. The degree and intensity of the postictal state significantly affects the patient's quality of life and is strongly associated with the patient's rating of the severity of the seizure, but receives little attention in the treatment of epilepsy, and anti-seizure medications prevent postictal events by making the patient seizures-free, or will attenuate or shorten the time after the seizure. Therefore, it is of great clinical significance to evaluate the efficacy of anti-seizure medications in the post-seizure state. This article reviews the effects of the main anti-seizure medications on the postictal state

Citation： CAO Lanlan, CHEN Yue, TAO Lihong. Effects of anti-seizure medications on postictal state of epilepsy. Journal of Epilepsy, 2024, 10(2): 147-151. doi: 10.7507/2096-0247.202401006 Copy

1.	Pottkamper JCM, Hofmeijer J, Van Waarde JA, et al. The postictal state - what do we know?. Epilepsia, 2020, 61(6): 1045-1061.
2.	Schmidt D. Effect of antiepileptic drugs on the postictal state. A critical overview. Epilepsy Behav, 2010, 19(2): 176-181.
3.	Shahisavandi M, Zeraatpisheh Z, Rostaminejad M, et al. Treatment of postictal headache: a systematic review and future directions. Epilepsy Behav, 2021, 119: 107971.
4.	Doudoux H, Fournier M, Vercueil L. Postictal syndrome: the forgotten continent. An overview of the clinical, biochemical and imaging features. Rev Neurol (Paris), 2020, 176(1-2): 62-74.
5.	Salma Z, Hanen HK, Salma S, et al. Headaches and their relationships to epileptic seizures. Epilepsy Behav, 2019, 90: 233-237.
6.	Josephson CB, Engbers JD, Sajobi TT, et al. An investigation into the psychosocial effects of the postictal state. Neurology, 2016, 86(8): 723-730.
7.	Abood W, Bandyopadhyay S. Postictal Seizure State. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Susanta Bandyopadhyay declares no relevant financial relationships with ineligible companies. 2023.
8.	Lyman KA, Chetkovich D. New insights into postictal paresis: an epilepsy-associated phenomenon that may not be as benign as long thought. Epilepsy Curr, 2017, 17(3): 167-168.
9.	Anwar H, Khan QU, Nadeem N, et al. Epileptic seizures. Discoveries (Craiova), 2020, 8(2): e110.
10.	Unterberger I, Trinka E, Ransmayr G, et al. Epileptic aphasia - a critical appraisal. Epilepsy Behav, 2021, 121(Pt A): 108064.
11.	Dupont S, Samson Y, Nguyen-Michel VH, et al. Lateralizing value of semiology in medial temporal lobe epilepsy. Acta Neurol Scand, 2015, 132(6): 401-409.
12.	Regala J, Lourenco J, Moniz-Pereira F, et al. Postictal psychosis: case report and literature review. Case Rep Psychiatry, 2023, 2023: 7960227.
13.	Tarrada A, Hingray C, Aron O, et al. Postictal psychosis, a cause of secondary affective psychosis: a clinical description study of 77 patients. Epilepsy Behav, 2022, 127: 108553.
14.	Braatz V, Martins Custodio H, Leu C, et al. Postictal psychosis in epilepsy: a clinicogenetic study. Annals of Neurology, 2021, 90(3): 464-476.
15.	Trimble M, Kanner A, Schmitz B. Postictal psychosis. Epilepsy Behav, 2010, 19(2): 159-161.
16.	Adachi N, Kanemoto K, De Toffol B, et al. Basic treatment principles for psychotic disorders in patients with epilepsy. Epilepsia, 2013, 54(Suppl 1): 19-33.
17.	Kumar A, Sharma S. Complex partial seizure. StatPearls. Treasure Island (FL). 2023.
18.	Xu SY, Li ZX, Wu XW, et al. Frequency and pathophysiology of post-seizure todd's paralysis. Med Sci Monit, 2020, 26: e920751.
19.	Loesch AM, Steger H, Losher C, et al. Seizure-associated aphasia has good lateralizing but poor localizing significance. Epilepsia, 2017, 58(9): 1551-1555.
20.	Baker GA, Smith DF, Dewey M, et al. The development of a seizure severity scale as an outcome measure in epilepsy. Epilepsy Res, 1991, 8(3): 245-251.
21.	Scott-Lennox J, Bryant-Comstock L, Lennox R, et al. Reliability, validity and responsiveness of a revised scoring system for the Liverpool Seizure Severity Scale. Epilepsy Res, 2001, 44(1): 53-63.
22.	Cramer JA, Baker GA, Jacoby A. Development of a new seizure severity questionnaire: initial reliability and validity testing. Epilepsy Res, 2002, 48(3): 187-197.
23.	Borghs S, De La Loge C, Brabant Y, et al. Sensitivity testing of the seizure severity questionnaire (SSQ). Epilepsy Behav, 2014, 31: 281-285.
24.	冯海燕, 郑乃智. 5种抗癫痫药物对癫痫发作后状态影响的临床研究. 潍坊医学院学报, 2015, 37(4): 250-253.
25.	Bryant-Comstock L, Scott-Lennox J, Lennox R. Assessment of seizure severity with adjunctive lamotrigine therapy: results from a U. S. observational study. Epilepsy Behav, 2001, 2(2): 152-157.
26.	Tilz C, Stefan H, Hopfengaertner R, et al. Influence of levetiracetame on ictal and postictal EEG in patients with partial seizures. Eur J Neurol, 2006, 13(12): 1352-1358.
27.	Kerr MP, Baker GA, Brodie MJ. A randomized, double-blind, placebo-controlled trial of topiramate in adults with epilepsy and intellectual disability: Impact on seizures, severity, and quality of life. Epilepsy & Behavior, 2005, 7(3): 472-480.
28.	Baker GA, Currie NG, Light MJ, et al. The effects of adjunctive topiramate therapy on seizure severity and health-related quality of life in patients with refractory epilepsy---a Canadian study. Seizure, 2002, 11(1): 6-15.
29.	Dupont S, Striano S, Trinka E, et al. Flexible dosing of adjunctive zonisamide in the treatment of adult partial-onset seizures: a non-comparative, open-label study (ZEUS). Acta Neurol Scand, 2010, 121(3): 141-148.
30.	龚帆影, 陈钰霖, 周晶晶. 用奥卡西平对癫痫患者进行治疗对其认知功能影响的研究. 当代医药论丛, 2019, 17(10): 179-180.
31.	Demir M, Akarsu EO, Dede HO, et al. Investigation of the roles of new antiepileptic drugs and serum bdnf levels in efficacy and safety monitoring and quality of life: a clinical research. Current Clinical Pharmacology, 2020, 15(1): 49-63.
32.	Zhu H, Deng X, Feng L, et al. Efficacy comparison of oxcarbazepine and levetiracetam monotherapy among patients with newly diagnosed focal epilepsy in China: a multicenter, open-label, randomized study. CNS Neurosci Ther, 2022, 28(7): 1072-1080.
33.	Liu WT, Yan XX, Cheng DZ, et al. Oxcarbazepine monotherapy in children with benign epilepsy with centrotemporal spikes improves quality of life. Chin Med J (Engl), 2020, 133(14): 1649-1654.
34.	Cramer JA, Colman S, Anastassopoulos KP, et al. Associations between seizure severity change and patient characteristics, changes in seizure frequency, and health-related quality of life in patients with focal seizures treated with adjunctive eslicarbazepine acetate: post hoc analyses of clinical trial results. Epilepsy Behav, 2020, 112: 107312.
35.	Lancman ME, Fertig EJ, Trobliger RW, et al. The effects of lacosamide on cognition, quality-of-life measures, and quality of life in patients with refractory partial epilepsy. Epilepsy & Behavior, 2016, 61: 27-33.
36.	Pozzi M, Zanotta N, Epifanio R, et al. Lacosamide effectiveness and tolerability in patients with drug-resistant epilepsy and severe disability under polytherapy: Therapy optimization as emerging from an observational study. Epilepsy Behav, 2022, 128(1525-5069 (Electronic)): 108598.
37.	Glauser T, Kluger G, Sachdeo R, et al. Rufinamide for generalized seizures associated with Lennox-Gastaut syndrome. Neurology, 2008, 70(21): 1950-1958.
38.	Farrell JS, Greba Q, Snutch TP, et al. Fast oxygen dynamics as a potential biomarker for epilepsy. Sci Rep, 2018, 8(1): 17935.
39.	Lim HK, Bae S, Han K, et al. Seizure-induced neutrophil adhesion in brain capillaries leads to a decrease in postictal cerebral blood flow. iScience, 2023, 26(5): 106655.
40.	Farrell JS, Colangeli R, Wolff MD, et al. Postictal hypoperfusion/hypoxia provides the foundation for a unified theory of seizure-induced brain abnormalities and behavioral dysfunction. Epilepsia, 2017, 58(9): 1493-1501.
41.	Farrell JS, Colangeli R, Dudok B, et al. In vivo assessment of mechanisms underlying the neurovascular basis of postictal amnesia. Sci Rep, 2020, 10(1): 14992.
42.	Farrell JS, Gaxiola-Valdez I, Wolff MD, et al. Postictal behavioural impairments are due to a severe prolonged hypoperfusion/hypoxia event that is COX-2 dependent. Elife, 2016: 5(Electronic).
43.	Villa BR, George AG, Shutt TE, et al. Postictal hypoxia involves reactive oxygen species and is ameliorated by chronic mitochondrial uncoupling. Neuropharmacology, 2023, 238(18): 109653.
44.	李昕, 孙雅萍, 张鸿. 癫痫共患偏头痛的研究进展. 中国实用神经疾病杂志, 2021, 24(1): 83-87.
45.	Mesraoua B, Brigo F, Lattanzi S, et al. Drug-resistant epilepsy: definition, pathophysiology, and management. J Neurol Sci, 2023, 452(78): 120766.
46.	常一凡, 罕迦尔别克·库锟, 徐蕊, 等. 难治性癫痫发作控制前后海马体积的变化及评价. 中国实用神经疾病杂志, 2023, 26(5): 560-565.
47.	Tedrus G, Augusto MN, Bonolo HPB. Perception of seizure severity and bothersome in refractory focal epilepsy. Rev Neurol (Paris), 2022, 178(6): 603-608.
48.	Gao L, Xia L, Pan SQ, et al. Psychometric properties of Chinese language Liverpool Seizure Severity Scale 2.0 (LSSS 2.0) and status and determinants of seizure severity for patients with epilepsy in China. Epilepsy Behav, 2014, 31: 187-193.
49.	Li E, D'esterre CD, Gaxiola-Valdez I, et al. CT perfusion measurement of postictal hypoperfusion: localization of the seizure onset zone and patterns of spread. Neuroradiology, 2019, 61(9): 991-1010.
50.	Li E, D'esterre CD, Lee TY, et al. Quantitatively detecting postictal hypoperfusion in patients with focal epilepsy using CT perfusion: Determining cross-modality comparisons and electrode artifacts. J Neurosci Methods, 2019, 314(1): 13-20.

1. Pottkamper JCM, Hofmeijer J, Van Waarde JA, et al. The postictal state - what do we know?. Epilepsia, 2020, 61(6): 1045-1061.
2. Schmidt D. Effect of antiepileptic drugs on the postictal state. A critical overview. Epilepsy Behav, 2010, 19(2): 176-181.
3. Shahisavandi M, Zeraatpisheh Z, Rostaminejad M, et al. Treatment of postictal headache: a systematic review and future directions. Epilepsy Behav, 2021, 119: 107971.
4. Doudoux H, Fournier M, Vercueil L. Postictal syndrome: the forgotten continent. An overview of the clinical, biochemical and imaging features. Rev Neurol (Paris), 2020, 176(1-2): 62-74.
5. Salma Z, Hanen HK, Salma S, et al. Headaches and their relationships to epileptic seizures. Epilepsy Behav, 2019, 90: 233-237.
6. Josephson CB, Engbers JD, Sajobi TT, et al. An investigation into the psychosocial effects of the postictal state. Neurology, 2016, 86(8): 723-730.
7. Abood W, Bandyopadhyay S. Postictal Seizure State. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Susanta Bandyopadhyay declares no relevant financial relationships with ineligible companies. 2023.
8. Lyman KA, Chetkovich D. New insights into postictal paresis: an epilepsy-associated phenomenon that may not be as benign as long thought. Epilepsy Curr, 2017, 17(3): 167-168.
9. Anwar H, Khan QU, Nadeem N, et al. Epileptic seizures. Discoveries (Craiova), 2020, 8(2): e110.
10. Unterberger I, Trinka E, Ransmayr G, et al. Epileptic aphasia - a critical appraisal. Epilepsy Behav, 2021, 121(Pt A): 108064.
11. Dupont S, Samson Y, Nguyen-Michel VH, et al. Lateralizing value of semiology in medial temporal lobe epilepsy. Acta Neurol Scand, 2015, 132(6): 401-409.
12. Regala J, Lourenco J, Moniz-Pereira F, et al. Postictal psychosis: case report and literature review. Case Rep Psychiatry, 2023, 2023: 7960227.
13. Tarrada A, Hingray C, Aron O, et al. Postictal psychosis, a cause of secondary affective psychosis: a clinical description study of 77 patients. Epilepsy Behav, 2022, 127: 108553.
14. Braatz V, Martins Custodio H, Leu C, et al. Postictal psychosis in epilepsy: a clinicogenetic study. Annals of Neurology, 2021, 90(3): 464-476.
15. Trimble M, Kanner A, Schmitz B. Postictal psychosis. Epilepsy Behav, 2010, 19(2): 159-161.
16. Adachi N, Kanemoto K, De Toffol B, et al. Basic treatment principles for psychotic disorders in patients with epilepsy. Epilepsia, 2013, 54(Suppl 1): 19-33.
17. Kumar A, Sharma S. Complex partial seizure. StatPearls. Treasure Island (FL). 2023.
18. Xu SY, Li ZX, Wu XW, et al. Frequency and pathophysiology of post-seizure todd's paralysis. Med Sci Monit, 2020, 26: e920751.
19. Loesch AM, Steger H, Losher C, et al. Seizure-associated aphasia has good lateralizing but poor localizing significance. Epilepsia, 2017, 58(9): 1551-1555.
20. Baker GA, Smith DF, Dewey M, et al. The development of a seizure severity scale as an outcome measure in epilepsy. Epilepsy Res, 1991, 8(3): 245-251.
21. Scott-Lennox J, Bryant-Comstock L, Lennox R, et al. Reliability, validity and responsiveness of a revised scoring system for the Liverpool Seizure Severity Scale. Epilepsy Res, 2001, 44(1): 53-63.
22. Cramer JA, Baker GA, Jacoby A. Development of a new seizure severity questionnaire: initial reliability and validity testing. Epilepsy Res, 2002, 48(3): 187-197.
23. Borghs S, De La Loge C, Brabant Y, et al. Sensitivity testing of the seizure severity questionnaire (SSQ). Epilepsy Behav, 2014, 31: 281-285.
24. 冯海燕, 郑乃智. 5种抗癫痫药物对癫痫发作后状态影响的临床研究. 潍坊医学院学报, 2015, 37(4): 250-253.
25. Bryant-Comstock L, Scott-Lennox J, Lennox R. Assessment of seizure severity with adjunctive lamotrigine therapy: results from a U. S. observational study. Epilepsy Behav, 2001, 2(2): 152-157.
26. Tilz C, Stefan H, Hopfengaertner R, et al. Influence of levetiracetame on ictal and postictal EEG in patients with partial seizures. Eur J Neurol, 2006, 13(12): 1352-1358.
27. Kerr MP, Baker GA, Brodie MJ. A randomized, double-blind, placebo-controlled trial of topiramate in adults with epilepsy and intellectual disability: Impact on seizures, severity, and quality of life. Epilepsy & Behavior, 2005, 7(3): 472-480.
28. Baker GA, Currie NG, Light MJ, et al. The effects of adjunctive topiramate therapy on seizure severity and health-related quality of life in patients with refractory epilepsy---a Canadian study. Seizure, 2002, 11(1): 6-15.
29. Dupont S, Striano S, Trinka E, et al. Flexible dosing of adjunctive zonisamide in the treatment of adult partial-onset seizures: a non-comparative, open-label study (ZEUS). Acta Neurol Scand, 2010, 121(3): 141-148.
30. 龚帆影, 陈钰霖, 周晶晶. 用奥卡西平对癫痫患者进行治疗对其认知功能影响的研究. 当代医药论丛, 2019, 17(10): 179-180.
31. Demir M, Akarsu EO, Dede HO, et al. Investigation of the roles of new antiepileptic drugs and serum bdnf levels in efficacy and safety monitoring and quality of life: a clinical research. Current Clinical Pharmacology, 2020, 15(1): 49-63.
32. Zhu H, Deng X, Feng L, et al. Efficacy comparison of oxcarbazepine and levetiracetam monotherapy among patients with newly diagnosed focal epilepsy in China: a multicenter, open-label, randomized study. CNS Neurosci Ther, 2022, 28(7): 1072-1080.
33. Liu WT, Yan XX, Cheng DZ, et al. Oxcarbazepine monotherapy in children with benign epilepsy with centrotemporal spikes improves quality of life. Chin Med J (Engl), 2020, 133(14): 1649-1654.
34. Cramer JA, Colman S, Anastassopoulos KP, et al. Associations between seizure severity change and patient characteristics, changes in seizure frequency, and health-related quality of life in patients with focal seizures treated with adjunctive eslicarbazepine acetate: post hoc analyses of clinical trial results. Epilepsy Behav, 2020, 112: 107312.
35. Lancman ME, Fertig EJ, Trobliger RW, et al. The effects of lacosamide on cognition, quality-of-life measures, and quality of life in patients with refractory partial epilepsy. Epilepsy & Behavior, 2016, 61: 27-33.
36. Pozzi M, Zanotta N, Epifanio R, et al. Lacosamide effectiveness and tolerability in patients with drug-resistant epilepsy and severe disability under polytherapy: Therapy optimization as emerging from an observational study. Epilepsy Behav, 2022, 128(1525-5069 (Electronic)): 108598.
37. Glauser T, Kluger G, Sachdeo R, et al. Rufinamide for generalized seizures associated with Lennox-Gastaut syndrome. Neurology, 2008, 70(21): 1950-1958.
38. Farrell JS, Greba Q, Snutch TP, et al. Fast oxygen dynamics as a potential biomarker for epilepsy. Sci Rep, 2018, 8(1): 17935.
39. Lim HK, Bae S, Han K, et al. Seizure-induced neutrophil adhesion in brain capillaries leads to a decrease in postictal cerebral blood flow. iScience, 2023, 26(5): 106655.
40. Farrell JS, Colangeli R, Wolff MD, et al. Postictal hypoperfusion/hypoxia provides the foundation for a unified theory of seizure-induced brain abnormalities and behavioral dysfunction. Epilepsia, 2017, 58(9): 1493-1501.
41. Farrell JS, Colangeli R, Dudok B, et al. In vivo assessment of mechanisms underlying the neurovascular basis of postictal amnesia. Sci Rep, 2020, 10(1): 14992.
42. Farrell JS, Gaxiola-Valdez I, Wolff MD, et al. Postictal behavioural impairments are due to a severe prolonged hypoperfusion/hypoxia event that is COX-2 dependent. Elife, 2016: 5(Electronic).
43. Villa BR, George AG, Shutt TE, et al. Postictal hypoxia involves reactive oxygen species and is ameliorated by chronic mitochondrial uncoupling. Neuropharmacology, 2023, 238(18): 109653.
44. 李昕, 孙雅萍, 张鸿. 癫痫共患偏头痛的研究进展. 中国实用神经疾病杂志, 2021, 24(1): 83-87.
45. Mesraoua B, Brigo F, Lattanzi S, et al. Drug-resistant epilepsy: definition, pathophysiology, and management. J Neurol Sci, 2023, 452(78): 120766.
46. 常一凡, 罕迦尔别克·库锟, 徐蕊, 等. 难治性癫痫发作控制前后海马体积的变化及评价. 中国实用神经疾病杂志, 2023, 26(5): 560-565.
47. Tedrus G, Augusto MN, Bonolo HPB. Perception of seizure severity and bothersome in refractory focal epilepsy. Rev Neurol (Paris), 2022, 178(6): 603-608.
48. Gao L, Xia L, Pan SQ, et al. Psychometric properties of Chinese language Liverpool Seizure Severity Scale 2.0 (LSSS 2.0) and status and determinants of seizure severity for patients with epilepsy in China. Epilepsy Behav, 2014, 31: 187-193.
49. Li E, D'esterre CD, Gaxiola-Valdez I, et al. CT perfusion measurement of postictal hypoperfusion: localization of the seizure onset zone and patterns of spread. Neuroradiology, 2019, 61(9): 991-1010.
50. Li E, D'esterre CD, Lee TY, et al. Quantitatively detecting postictal hypoperfusion in patients with focal epilepsy using CT perfusion: Determining cross-modality comparisons and electrode artifacts. J Neurosci Methods, 2019, 314(1): 13-20.

Journal of Epilepsy

Effects of anti-seizure medications on postictal state of epilepsy

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