During this clonic phase the tongue can be bitten, and frothy and bloody sputum may be seen coming out of the mouth. The postictal phase begins once the twitching movements end. The patient is initially in a deep sleep, breathing deeply, and then gradually wakes up. Postictal confusion or agitation is common.
Events that occur during sleep or in the transition periods between sleep and wakefulness have a largely separate differential diagnosis that includes a variety of rapid eye movement (REM) and nonREM parasomnias (eg, REM sleep behavior disorder, sleepwalking, confusional arousals), as well as isolated sleep paralysis and psychiatric events (table 8). (See "Approach to abnormal movements and behaviors during sleep".)
A seizure is a sudden change in behavior caused by electrical hypersynchronization of neuronal networks in the cerebral cortex.
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