Clinical approaches to postictal state assessment: Insights from an international survey of epilepsy care providers

Abstract

Purpose

Postictal assessment is essential for seizure localization during presurgical evaluation and for identifying serious complications such as sudden unexpected death in epilepsy. This study aimed to evaluate the current clinical practices and attitudes of epilepsy care providers toward postictal state assessment in routine clinical settings.

Methods

A cross-sectional online survey was conducted using the Google Forms platform between May and August 2023. The questionnaire included five sections addressing participant demographics, postictal clinical and EEG assessment practices, key monitoring tools, and perspectives on incorporating postictal evaluation into routine care. Participants were stratified into higher-income and lower-income country groups based on World Bank classifications.

Results

A total of 155 participants from 32 countries completed the survey, of whom 79.4 % were neurologists. Only 50 % reported applying the standardized postictal test proposed by the International League Against Epilepsy in 2016. Postictal psychosis was routinely assessed by only a minority of providers, with significantly fewer in higher-income countries (24.5 %) compared to lower-income countries (41.2 %; p = 0.04). Approximately one-third of respondents in both groups did not monitor oxygen saturation postictally. Among those with access to long-term video EEG, only 57.6 % reported assessing both postictal generalized EEG suppression and polymorphic delta activity. Despite these gaps, nearly all respondents supported the integration of postictal assessment into routine epilepsy care.

Conclusions

The results highlight significant gaps in postictal assessment practices across countries regardless of income level or clinical experience and emphasize the need for improved training and standardized protocols to enhance patient safety and diagnostic accuracy.