Abstracts

Rationale: In the postictal period, individuals with epilepsy experience an array of physical, cognitive and psychiatric symptoms lasting anywhere from seconds to days. These symptoms can have a lasting impact on their quality-of-life as well as their mental and physical health. Therefore we aim to determine the occurrence, frequency and duration of symptoms after a seizure to better characterize the postictal period. Methods: Our quantitative and qualitative questionnaire was adapted from MacEachern et al. (2017) who administered a similar survey in children. The survey was modified based on expert feedback and input from patients from a large tertiary care health system and consisted of 14 physical, cognitive, and psychiatric signs and symptoms. Consecutive patients seen in these tertiary clinics who had agreed to participate in research and had experienced a seizure in the prior 2 years were approached to complete the survey. Fisher Exact test and logistic regression was used to explore associations between seizure/epilepsy type and symptoms with consideration of age and sex. SAS 9.4 was used and a p value of 0.05 was considered significant. Thematic content analysis was completed in duplicate using NVivo 12 Plus to analyze what alleviates or worsens symptoms in the postictal period. Researchers independently assigned descriptive codes and met to discuss common themes. Results: We approached 351 patients of whom 313 agreed to complete the survey (89%). Fifteen participants were excluded due to incomplete surveys, missing registry data or not having epilepsy. Of the 298 final participants, 54% were females and the mean age was 40 years (SD=15.6). The three most commonly reported symptoms were postictal fatigue/sleepiness/tiredness (84%), confusion/difficulty thinking clearly (75%) and memory problems (69%). The three least reported symptoms were delusions/hallucinations (8%), restlessness (20%) and vision changes or impairments (23%) Experiencing all three seizure types (focal aware, focal impaired aware and bilateral tonic-clonic) in the last two years was significantly associated with weakness/inability to move normally compared to experiencing only two of these three seizures types (OR=2.53; 95% CI 1.09-5.87). Similarly, there was a significant association between individuals with generalized epilepsy and weakness/inability to move normally compared to focal epilepsy (OR=1.95; 95% Cl 1.08-3.53). Sleep or rest, medication, and comfort were most commonly identified for alleviating symptoms during the postictal period. Whereas activity, lack of rest or sleep, and stress were reported to exacerbate symptoms during this time. Conclusions: These findings can be used to inform all those that are involved in the care of individuals with epilepsy about the occurrence of these symptoms during the postictal period. Furthermore, this work contributes towards a better understanding of this time and aids in the development of future interventions to minimize the impact of the postictal period on persons with epilepsy. Funding: Canadian Institutes of Health Research, Alberta Health, Hotchkiss Brain Institute, University Of Calgary Cumming School Of Medicine, National Institute of Health, Natural Sciences and Engineering Research Council, and Alberta Innovates Summer Studentship.