CNS depression after an acute generalised tonic clinic seizure - “The ghostly calm after the plundering cyclone.”

 An all pervasive, flooding of electrical activity occurs during an episode of generalised tonic clinic seizure. The abnormal electrical disturbances get manifested in the form of sustained, severe, generalised and vigorous contractions of all or most of the group of the muscles of the body. The condition is a medical emergency and unless  intervened promptly with the right medical therapy, is often fatal. In the aftermath of the serious event, the patient goes into an obtunded state. This phase which occurs after the episode of convulsion is known as the post-ictal state. Mostly, the patients sleep for prolonged periods, sometimes with audible snoring. The underlying mechanism of the post-ictal state is not clearly known, but the ‘storm’ that has passed during the episode of GTCS must have ‘inflicted’ a state of ‘refractoriness’ to the neurons. Likely, in such a state, the ‘routine’ transmission of impulses suffer a major ‘setback’ throwing the patient into a state of CNS depression. We can also speculate that there has been depletion of neurotransmitters from the presynaptic neurons during the ‘agitated’ phase of seizure. Collectively, the post-ictal phase is an inactive state of the brain where the higher cognitive functions, the autonomic system and the peripheral nervous system are highly subdued and suppressed.