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Following the typical postictal confusion and lethargy, the person gradually recovers to a normal lucid state. In persons who experience postictal psychosis, this "lucid phase" usually continues at least 6 hours (and up to a week), followed by the psychosis lasting as little as one hour to more than 3 months (the mean is 9–10 days).
However, the "reason for the close relationship of TEA with sleep is unclear. It may be that the transition from sleep to waking acts as a trigger to a seizure focus in the medial temporal lobe. Alternatively, amnesia upon waking may reflect persistent post-ictal dysfunction of medial temporal lobe structures following a seizure during sleep." [2]
Other post-ictal neurological findings that do not involve activity of the area affected by the seizure have been described. They are thought to be caused by a different mechanism than Todd's paresis, and including paralysis of the contralateral limb, [ 5 ] and rare genetic causes of hemiplegia and seizures.
Post-ictal headache. It is a headache “occurring within three hours after an epileptic seizure and remitting spontaneously within 72 hours after seizure termination”. [ 4 ] It is one of the possible symptoms of the postictal state .
Other symptoms frequently associated with PPP include confusion, disorganized thought, severe difficulty sleeping, variations of mood disorders (including depression, agitation, mania, or a combination of the above), as well as cognitive features such as consciousness that comes and goes (waxing and waning) or disorientation.
Some characteristics which may distinguish PNES from epileptic seizures include gradual onset, out-of-phase limb movement (in which left and right extremities jerk asynchronously or in opposite directions, as opposed to rhythmically and simultaneously as in epileptic seizures), closed eyes, high memory recall, and lack of post-ictal confusion.
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The ACDU scale, like AVPU, is easier to use than the GCS and produces similarly accurate results. [10] Using ACDU, a patient is assessed for alertness, confusion, drowsiness, and unresponsiveness. [10] The Grady Coma Scale classes people on a scale of I to V along a scale of confusion, stupor, deep stupor, abnormal posturing, and coma. [9]