338:(PET) scanning of radiolabelled ligands before, during, and after spontaneous seizures in humans. They found that opioid receptors were upregulated in the regions near the focus of the seizure during the ictal phase, gradually returning to baseline availability during the postictal phase. Hammers notes that cerebral bloodflow after a seizure cannot account for the increase in PET activity observed. Regional bloodflow can increase by as much as 70–80% after seizures but normalizes after 30 minutes. The shortest postictal interval in their study was 90 minutes and none of the patients had seizures during the scanning. It has been predicted that a decrease in opioid activity following a seizure could cause withdrawal symptoms, contributing to postictal depression. The opioid receptor connection with mitigating seizures has been disputed, and opioids have been found to have different functions in different regions of the brain, having both proconvulsive and anticonvulsive effects.
399:
it has been shown that sometimes cerebral blood flow is not proportionate to metabolism. While cerebral blood flow didn't change in the mouse hippocampus (the foci of seizures in this model) during or after seizures, increases in relative glucose uptake were observed in the region during the ictal and early postictal periods. Animal models are difficult for this type of study because each type of seizure model produces a unique pattern of perfusion and metabolism. Thus, in different models of epilepsy, researchers have had differing results as to whether or not metabolism and perfusion become uncoupled. Hosokawa's model used EL mice, in which seizures begin in the
228:. 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). The psychosis is typically treated medically using
382:. With continued contractions under anaerobic conditions, the cells undergo lactic acidosis, or the production of lactic acid as a metabolic byproduct. This acidifies the blood (higher H+ concentration, lower pH), which has many impacts on the brain. For one, “hydrogen ions compete with other ions at the ion channel associated with N-methyl-d-aspartate (
333:
may be occurring during seizures and may be partially responsible for the weariness humans experience following a seizure. When humans were given naloxone in-between seizures, researchers observed increased activity on their EEGs, suggesting that opioid receptors may also be upregulated during human
398:
typically ensures that the correct amount of blood reaches the various regions of the brain to match the activity of the cells in that region. In other words, perfusion typically matches metabolism in all organs; especially in the brain, which gets the highest priority. However, following a seizure
304:
terminal and then exocytosed into the synaptic cleft in order to propagate the signal to the next neuron. While neurotransmitters are not typically a limiting factor in neuronal signaling rates, it is possible that with extensive firing during seizures neurotransmitters could be used up faster than
825:
Quote: "Patients who are aware of increased depression or tension prior to generalized tonic-clonic or limbic seizures occasionally report a feeling of euphoria or release during the postictal period atients with interictal or preictal depression can report relief or euphoria postictally, which is
267:
The postictal state can also be useful for determining the focus of the seizure. Decreased verbal memory (short term) tends to result from a seizure in the dominant hemisphere, whereas seizures in the non-dominant hemisphere tend to manifest with decreased visual memory. Inability to read suggests
251:
do not produce a postictal state and some seizure types may have very brief postictal states. Otherwise, the lack of typical postictal symptoms, such as confusion and lethargy following convulsive seizures, may be a sign of non-epileptic seizures. Usually such seizures are instead related to
192:
is a temporary regional loss of function in whatever region just experienced the seizure, and its manifestation depends on where the seizure was located. Loss of motor function is most common and can range from weakness to full paralysis. About 6% of patients who had
362:
Leftover inhibitory signals are the most likely explanation for why there would be a period in which the threshold for provoking a second seizure is high, and lowered excitability may also explain some of the postictal symptoms. Inhibitory signals could be through
892:
Absence ... seizures begin and end suddenly. There is no warning before the seizure, and immediately afterward the person is alert and attentive. This lack of a postictal period is a key feature that allows one to distinguish between absence and partial complex
158:-induced reversible alterations in neuronal function but not structure." Commonly after a seizure, a person feels mentally and physically exhausted for up to one or two days. The most common complaint is an inability to think clearly, specifically "poor
243:
Postictal bliss or euphoria is also reported following seizures. This has been described as a highly blissful feeling associated with the emergence from amnesia. Feelings of depression before a seizure may lead to postictal euphoria.
359:, a period of weeks or even months following a series of seizures in which seizures cannot be induced (using animal models and a technique called kindling, in which seizures are induced with repeated electrical stimulation).
905:
Hammers, Alexander; Asselin, Marie-Claude; Hinz, Rainer; Kitchen, Ian; Brooks, David J.; Duncan, John S.; Koepp, Matthias J. (14 April 2007). Newsom-David, John; Husain, Masud; Al-Chalabi, Ammar; Mallucci, Giovanna (eds.).
346:
It is possible that seizures cease spontaneously, but it is much more probable that some changes in the brain create inhibitory signals that serve to tamp down the overactive neurons and effectively end the seizure.
378:
of the blood could aid in ending the seizure and also depress neuron firing following its conclusion. As muscles contract during tonic-clonic seizures they outpace oxygen supplies and go into
130:
disorder. For most people with epilepsy, the interictal state corresponds to more than 99% of their life. The interictal period is often used by neurologists when diagnosing epilepsy since an
1001:
Hosokawa, Chisa; Ochi, Hironobu; Yamagami, Sakae; Yamada, Ryusaku (1 April 1997). Goldsmith, Stanley J.; Murphy, Dawn; Sonnemaker, Robert E.; Silver, Stacey; Tapscott, Eleanore (eds.).
212:
Postictal psychosis is a neuropsychiatric sequel to seizures of chronic epilepsy in adults. Tending to occur with bilateral seizure types it is characterized by auditory and visual
69:
period is the seizure itself; the interictal period is the time between seizures, when brain activity is more normal; and the preictal period is the time leading up to a seizure:
826:
consistent with the well-known beneficial effect of electroconvulsive shock therapy (ECT). Postictal hypomania can occur, particularly after repeated limbic seizures."
197:
experienced Todd's paresis afterward, with loss of motor function sometimes accompanied with temporary numbness, blindness, or deafness. Todd's paresis can also cause
305:
new ones could be synthesized in the cell and transported down the axon. There is currently no direct evidence for neurotransmitter depletion following seizures.
403:
and present similarly to the behaviors observed in human epileptic patients. If humans show similar uncoupling of perfusion and metabolism, this would result in
355:
has also been implicated as a molecule potentially involved in terminating seizures. Evidence for the theory of active inhibition lies in the postictal
1019:
284:
While it might seem that the neurons become “exhausted” after the near-constant firing involved in a seizure, the ability of the neuron to carry an
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883:
624:
812:
38:. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures, and is characterized by
887:
907:
98:(EEG), the recording during a seizure is said to be "ictal". The following definitions refer to the temporal relation with seizures.
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1366:
209:
if the seizures began in the language-dominant hemisphere. Symptoms typically last about 15 hours, but can continue for 36 hours.
436:
1280:
194:
1413:
1074:
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1300:
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following a seizure is not decreased. Neurons of the brain fire normally when stimulated, even after long periods of
257:
268:
seizure foci in the language areas of the left hemisphere, and "after a seizure semivoluntary events as mundane as
407:
in the affected area, a possible explanation for the confusion and 'fog' patients experience following a seizure.
386:). This competition may partially attenuate NMDA receptor and channel mediated hyperexcitability after seizures.”
185:. At times, a person may be unaware of having had a seizure, and the characteristic migraine is their only clue.
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31:
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724:
Devinsky, Orrin (26 February 2008). Spencer, David; Jehi, Lara E.; Won, Michael; Danzer, Steve C. (eds.).
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immediately reverses this state, providing evidence that increased responsiveness or concentration of the
170:, decreased verbal and interactive skills, and a variety of cognitive defects specific to individuals."
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1305:
1010:
1310:
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859:
751:
247:
Some of postictal symptoms are almost always present for a period of a few hours up to a day or two.
351:
peptides have been shown to be involved in the postictal state and are at times anticonvulsive, and
1520:
1257:
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557:
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1002:
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229:
95:
822:
142:. Interictal EEG discharges are those abnormal waveforms not associated with seizure symptoms.
1295:
1242:
840:. In Bromfield, Edward B.; Cavazos, José E.; Sirven, Joseph I.; Rogawski, Michael A. (eds.).
441:
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979:
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139:
131:
8:
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1003:"Regional cerebral blood flow and glucose utilization in spontaneously epileptic EL mice"
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135:
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725:
694:
623:
Fisher, Robert S.; Schachter, Steven C. (1 February 2000). Schachter, Steven C. (ed.).
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289:
253:
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Mula, Marco; Monaco, Francesco (23 March 2011). Cavanna, A.E.; Trojano, Luigi (eds.).
367:(both fast and slow IPSPs), calcium-activated potassium receptors (which give rise to
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237:
908:"Upregulation of opioid receptor binding following spontaneous epileptic seizures"
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273:
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912:
539:
330:
269:
841:
371:), hyperpolarizing pumps, or other changes in ion channels or signal receptors.
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106:
refers to the state immediately before the actual seizure, stroke, or headache.
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51:
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202:
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625:"The postictal state: a neglected entity in the management of epilepsy"
225:
123:
39:
173:
Postictal migraine headaches are a major complaint among persons with
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322:
217:
178:
159:
43:
188:
Other symptoms associated with the postictal state are less common.
177:, and can have a variety of etiologies. One possible cause of these
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743:
650:
375:
326:
221:
174:
127:
87:
59:
55:
836:
Bromfield, Edward B.; Cavazos, José E.; Sirven, Joseph I. (2006).
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seizures. To provide direct evidence for this, Hammers et al. did
925:
739:
642:
549:
454:
206:
155:
79:
17:
959:
575:
317:, seizures are followed by unconsciousness and slow waves on an
921:
638:
545:
450:
348:
83:
47:
66:
383:
301:
1000:
1020:
Society of
Nuclear Medicine and Molecular Imaging (SNMMI)
904:
313:
In studies that stimulate seizures by subjecting rats to
23:
Altered state of consciousness after an epileptic seizure
726:"Postictal Psychosis: Common, Dangerous, and Treatable"
181:
is high intracranial pressure resulting from postictal
835:
276:
to (that is on the same side as) the seizure focus."
884:
154:defines the postictal state as "manifestations of
138:and other abnormalities known by neurologists as
78:refers to a physiologic state or event such as a
1497:
932:: Guarantors of Brain (charitable organization)/
888:NLM (United States National Library of Medicine)
622:
544:. Conteporary neurology series (2nd ed.).
1075:
829:
114:refers to the state shortly after the event.
374:While not an example of active inhibition,
1082:
1068:
434:
122:refers to the period between seizures, or
90:. The word originates from the Latin word
1089:
941:
795:
618:
616:
494:
308:
300:Neurotransmitters must be present in the
1450:Citizens United for Research in Epilepsy
723:
614:
612:
610:
608:
606:
604:
602:
600:
598:
596:
994:
717:
530:
528:
526:
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898:
437:"Ictal and peri-ictal psychopathology"
325:. Administering the opiate antagonist
201:if the seizure included the bilateral
1063:
818:
593:
534:
389:
146:
1367:Dentatorubral–pallidoluysian atrophy
523:
341:
295:
240:can resolve the psychotic episodes.
1414:Sudden unexpected death in epilepsy
62:, and other disorienting symptoms.
13:
1344:Complex partial status epilepticus
14:
1532:
1429:Psychogenic non-epileptic seizure
1301:Benign familial neonatal seizures
1253:Sleep-related hypermotor epilepsy
94:, meaning a blow or a stroke. In
764:10.1111/j.1535-7511.2008.00227.x
126:, that are characteristic of an
1389:Early myoclonic encephalopathy
1362:Progressive myoclonus epilepsy
838:"Chapter 2: Clinical Epilepsy"
823:Chapter 9: Periictal Phenomena
428:
272:tend to be done with the hand
32:altered state of consciousness
1:
934:Oxford University Press (OUP)
422:
1339:Epilepsia partialis continua
336:positron emission tomography
279:
134:trace will often show small
7:
1394:Juvenile myoclonic epilepsy
1372:Unverricht–Lundborg disease
1011:Journal of Nuclear Medicine
843:An Introduction to Epilepsy
410:
10:
1537:
1311:Myoclonic astatic epilepsy
321:(EEG), signs of postictal
15:
1462:Epilepsy Action Australia
1442:
1406:
1352:
1329:
1271:
1205:
1196:
1173:
1142:
1101:
860:American Epilepsy Society
752:American Epilepsy Society
1424:Landau–Kleffner syndrome
1258:Panayiotopoulos syndrome
856:United States of America
748:United States of America
224:, affective change, and
16:Not to be confused with
1306:Lennox–Gastaut syndrome
1188:Epilepsy and employment
630:Epilepsy & Behavior
558:Oxford University Press
230:atypical antipsychotics
1511:Electroencephalography
1238:Temporal lobe epilepsy
1158:Electroencephalography
659:10.1006/ebeh.2000.0023
369:afterhyperpolarization
309:Receptor concentration
96:electroencephalography
1243:Frontal lobe epilepsy
541:Seizures and Epilepsy
471:10.3233/ben-2011-0314
442:Behavioural Neurology
195:tonic–clonic seizures
1479:Epilepsy Research UK
1263:Vertiginous epilepsy
1183:Epilepsy and driving
1134:Epilepsy in children
943:10.1093/brain/awm012
380:anaerobic metabolism
319:electroencephalogram
140:subclinical seizures
1516:Medical terminology
1467:Epilepsy Foundation
1434:Epilepsy in animals
1114:Aura (warning sign)
199:anterograde amnesia
1354:Myoclonic epilepsy
1331:Status epilepticus
874:on 21 January 2011
390:Cerebral bloodflow
290:status epilepticus
258:psychogenic origin
147:Signs and symptoms
136:interictal spiking
1493:
1492:
1407:Related disorders
1402:
1401:
1248:Rolandic epilepsy
731:Epilepsy Currents
536:Engel, Jerome Jr.
357:refractory period
342:Active inhibition
296:Neurotransmitters
236:, and successful
168:short term memory
36:epileptic seizure
1528:
1484:Epilepsy Society
1473:Epilepsy Outlook
1316:Epileptic spasms
1228:Gelastic seizure
1203:
1202:
1129:Neonatal seizure
1084:
1077:
1070:
1061:
1060:
1055:
1054:
1052:
1050:
1007:
998:
992:
991:
989:
987:
978:. Archived from
945:
902:
896:
895:
881:
879:
870:. Archived from
833:
827:
816:
810:
809:
799:
721:
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714:
712:
710:
701:. Archived from
620:
591:
590:
584:
582:
532:
521:
520:
518:
516:
507:. Archived from
498:
432:
331:opiate receptors
286:action potential
249:Absence seizures
238:epilepsy surgery
1536:
1535:
1531:
1530:
1529:
1527:
1526:
1525:
1521:Neurophysiology
1496:
1495:
1494:
1489:
1456:Epilepsy Action
1438:
1398:
1348:
1325:
1321:Febrile seizure
1286:Absence seizure
1267:
1223:Complex partial
1192:
1175:Personal issues
1169:
1154:Investigations
1150:Anticonvulsants
1138:
1124:Epileptogenesis
1119:Postictal state
1097:
1088:
1058:
1048:
1046:
1005:
999:
995:
985:
983:
903:
899:
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875:
834:
830:
821:, p. 332,
817:
813:
722:
718:
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706:
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580:
578:
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524:
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511:on 18 June 2015
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234:benzodiazepines
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28:postictal state
24:
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12:
11:
5:
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1419:Todd's paresis
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1410:
1408:
1404:
1403:
1400:
1399:
1397:
1396:
1391:
1386:
1385:
1384:
1382:Lafora disease
1379:
1377:MERRF syndrome
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1369:
1358:
1356:
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1349:
1347:
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1335:
1333:
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1291:Atonic seizure
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1218:Simple partial
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1200:
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1177:
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1165:Epileptologist
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993:
982:on 2 June 2018
930:United Kingdom
897:
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811:
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705:on 2 June 2018
647:United Kingdom
592:
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554:United Kingdom
522:
459:United Kingdom
426:
424:
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419:
417:Ictal headache
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409:
396:autoregulation
391:
388:
365:GABA receptors
343:
340:
310:
307:
297:
294:
281:
278:
262:pseudoseizures
214:hallucinations
190:Todd's paresis
183:cerebral edema
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115:
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99:
22:
9:
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4:
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2:
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1443:Organizations
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1198:Seizure types
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1109:Seizure types
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936:: 1009–1016.
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848:West Hartford
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756:SAGE Journals
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651:Elsevier Inc.
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567:9780803632011
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405:hypoperfusion
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315:electroshock
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152:Jerome Engel
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52:hypertension
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1273:Generalised
1022:: 613–616.
852:Connecticut
653:: P52–P59.
401:hippocampus
274:ipsilateral
270:nose wiping
124:convulsions
1500:Categories
1296:Automatism
1143:Management
819:Engel 2013
780:2001215107
675:sn99008772
423:References
256:or have a
226:aggression
203:hippocampi
119:Interictal
111:Post-ictal
40:drowsiness
1036:807503641
1028:0161-5505
952:0006-8950
893:seizures.
772:1535-7597
758:: 31–34.
667:1525-5050
538:(2013) .
479:0953-4180
465:: 21–25.
394:Cerebral
353:adenosine
323:catalepsy
280:Mechanism
218:delusions
179:migraines
160:attention
103:Pre-ictal
44:confusion
34:after an
1506:Epilepsy
1234:Epilepsy
1214:Seizures
1095:epilepsy
1091:Seizures
976:17301080
960:66084758
868:20821849
806:18330462
788:47195748
744:Illinois
699:20393636
691:12609127
683:41569329
576:89007930
505:21447894
487:37773567
411:See also
376:acidosis
327:naloxone
222:paranoia
175:epilepsy
128:epilepsy
88:headache
60:migraine
56:headache
1049:22 July
1044:9098212
986:22 July
968:1536984
926:England
878:22 July
797:2265810
740:Chicago
709:22 July
643:England
581:22 July
550:England
515:22 July
496:5377957
463:Hindawi
455:England
254:syncope
207:aphasia
166:, poor
156:seizure
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205:, and
84:stroke
48:nausea
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1006:(PDF)
920:(4).
913:Brain
738:(2).
695:S2CID
637:(1).
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92:ictus
86:, or
67:ictal
1486:(UK)
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1093:and
1051:2021
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1024:ISSN
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