Understanding Heightened Seizure Risk: The Pro-Ictal State

NEJM Evid. 2023 Mar;2(3):EVIDe2300004. doi: 10.1056/EVIDe2300004. Epub 2023 Feb 28.


The large-scale neuronal networks that underpin normal brain function are disrupted during seizures, which are characterized by a transition to abnormal, hypersynchronous neuronal activity. Many factors can contribute to transitions from interictal to ictal states, and an enduring predisposition to spontaneous, dynamic changes results in recurrent seizures - that is, epilepsy. Unpredictability and the apparent randomness of seizure occurrence seem to be a hallmark of many epilepsies, yet clinicians and patients are aware of periods during which a variety of converging factors may increase the risk of seizures.

Publication types

  • Editorial

MeSH terms

  • Brain
  • Electroencephalography* / methods
  • Epilepsy*
  • Humans
  • Neurons
  • Seizures