Effects of sleep on the postictal state

The postictal state can be particularly confusing when occurring in association with sleep. Some seizures tend to occur predominantly or exclusively during sleep; as the patient may be unaware of the seizure itself, the postictal state may be the only observed manifestation. Seizures and postictal phenomena occurring during sleep can also lead to diagnostic confusion particularly with parasomnias. Confusion or apparent sleepwalking, for example, could be a postictal phenomenon or could be an independent parasomnia. Awareness of the various manifestations of sleep disorders, seizures, and postictal phenomena during sleep is critical to optimal diagnosis and treatment of patients with epilepsy.