Nonconvulsive status epilepticus and the postictal state

Postictal symptoms, because of activation of inhibitory systems, have to be distinguished from ongoing ictal activity. The categorical concept of pure ictal and pure postictal symptoms cannot be supported by clinical observation alone. Differentiation between postictal and ictal behavioral phenomena can be difficult even with the use of electroencephalography, as clear-cut definitions of ictal and postictal changes are not available. Five different aspects can be considered: (1) hallucinatory symptoms recorded during and after a seizure, (2) prolonged postictal confusional states, (3) prolonged postictal psychotic states, (4) epileptic and other encephalopathies, and (5) coma with or without clinical signs of nonconvulsive status epilepticus. Presenting symptoms and conceptual considerations are presented in this review.