Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1195 1403-29 Street, NW Calgary, AB T2N 2T9, Canada.
Epilepsy Behav. 2019 May;94:243-251. doi: 10.1016/j.yebeh.2019.03.014. Epub 2019 Apr 9.
The postictal period has many physical, behavioral, and cognitive manifestations associated with it. These signs and symptoms are common, can be quite debilitating, and can have a continued impact long after the seizure has ended. The purpose of this systematic review was to quantify the occurrence of postictal signs and symptoms, along with their frequency and duration in persons with epilepsy.
Cochrane Database of Systematic Reviews, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, and Scopus were searched from inception to November 29, 2017. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards were followed. Search terms included subject headings and text words such as convulsion, epilepsy, seizure, postictal, post seizure, seizure recovery, seizure end, Todd's paresis, and Todd's paralysis. Standardized forms were used to collect various study variables. Abstract and full-text review, data abstraction, and quality assessment were all done in duplicate. Study heterogeneity was assessed using the I-squared test, and a random effects model was used to determine estimates. Publication bias was evaluated using funnel plots.
From 7811 abstracts reviewed, 78 articles met eligibility criteria, with 31 postictal manifestations (signs and/or symptoms) described and 45 studies included in the meta-analysis. The majority of studies described postictal headaches, migraines, and psychoses, with mean weighted frequency of 33.0% [95% confidence interval (CI) 26.0-40.0], 16.0% [95% CI 10.0-22.0], and 4.0% [95% CI 2.0-5.0], respectively. The mean weighted proportions of manifestations ranged from 0.5% (subacute postictal aggression) to 96.2% (postictal unresponsiveness) with symptom duration usually lasting <24 h but up to 2 months for physical and cognitive/behavioral symptoms respectively.
Examining data on the various signs and symptoms of the postictal period will have practical applications for physicians by raising their awareness about these manifestations and informing them about the importance of optimizing their prevention and treatment in epilepsy.
发作后时期有许多与身体、行为和认知相关的表现。这些迹象和症状很常见，可能非常虚弱，并在癫痫发作结束后持续存在。本系统评价的目的是量化癫痫患者发作后迹象和症状的发生情况，以及它们的频率和持续时间。
从成立到 2017 年 11 月 29 日，我们在 Cochrane 系统评价数据库、CINAHL、EMBASE、MEDLINE、PsycINFO、Web of Science 和 Scopus 中进行了搜索。我们遵循了系统评价和荟萃分析的首选报告项目（PRISMA）报告标准。检索词包括主题词和文本词，如抽搐、癫痫、癫痫发作、发作后、发作后、癫痫发作恢复、癫痫发作结束、Todd 麻痹和 Todd 瘫痪。使用标准化表格收集各种研究变量。摘要和全文审查、数据提取和质量评估均由两人进行。使用 I 平方检验评估研究异质性，并使用随机效应模型确定估计值。使用漏斗图评估发表偏倚。
从 7811 篇摘要中，有 78 篇文章符合入选标准，描述了 31 种发作后表现（体征和/或症状），并对 45 项研究进行了荟萃分析。大多数研究描述了发作后头痛、偏头痛和精神病，加权平均频率分别为 33.0%[95%置信区间（CI）26.0-40.0]、16.0%[95%CI 10.0-22.0]和 4.0%[95%CI 2.0-5.0]。表现的加权平均比例范围从 0.5%（亚急性发作后攻击）到 96.2%（发作后无反应），症状持续时间通常<24 h，但身体和认知/行为症状分别可达 2 个月。
检查发作后时期各种迹象和症状的数据将对医生具有实际应用意义，提高他们对这些表现的认识，并告知他们优化癫痫预防和治疗的重要性。
