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We performed a systematic literature review following the Preferred Reporting Items for Systematic reviews and Meta\u2010Analyses (PRISMA) guidelines to identify the various postictal manifestations of seizures (paresis, psychosis, nose\u2010wiping, automatisms, language deficits, headache, autonomic disturbances, visual impairment, palinacousis, and memory disturbances). We specifically investigated its evidence in the lateralization and localization of the seizure focus by searching three databases (PubMed, Embase, Scopus) until January 03, 2024. We then assessed the possibility of selection and assessment bias and evaluated the confidence in the epileptogenic zone based on brain neuroimaging, intracranial electroencephalography, and surgical outcomes. Studies were classified as high quality if the potential for bias was low and the confidence in the epileptogenic zone was high. The majority of patients with postictal signs had temporal lobe epilepsy (TLE). Signs with the highest incidence of TLE were postictal automatisms (93%), postictal nose\u2010wiping (89%), postictal psychosis (84.9%), postictal language impairment (84.2%), and postictal autonomic signs (83.7%). Language dysfunction had a high occurrence in left TLE (96.4%); nose\u2010wiping had a high occurrence in ipsilateral TLE (82.1%). Paresis was always seen contralaterally to the epileptic focus and was more likely to occur in patients with frontal lobe epilepsy than other anatomical localizations (Odds\u2009=\u20091.5). Finally, patients with occipital lobe epilepsy had a significantly higher incidence of postictal headache (Odds\u2009=\u20098.3) compared to other lobar localizations. Even though occurring after seizure termination, postictal signs can have high lateralizing and localizing value in presurgical planning, along with other ancillary information.<\/jats:p>","DOI":"10.1002\/epd2.70248","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T07:00:40Z","timestamp":1776754840000},"page":"1033-1046","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Lateralizing and localizing value of postictal signs: A systematic review"],"prefix":"10.1002","volume":"28","author":[{"given":"Prachi","family":"Parikh","sequence":"first","affiliation":[{"name":"Department of Neurology Duke University Medical Center  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mays","family":"Khweileh","sequence":"additional","affiliation":[{"name":"Department of Neurology Duke University Medical Center  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8282-1034","authenticated-orcid":false,"given":"Georg","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Research Programme Biomedical Data Science Paracelsus Medical University  Salzburg Austria"},{"name":"Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, Member of European Reference Network EpiCARE Christian Doppler University Hospital, Paracelsus Medical University  Salzburg Austria"},{"name":"Department of Artificial Intelligence and Human Interfaces Paris Lodron University  Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Hendren","sequence":"additional","affiliation":[{"name":"Duke University Medical Center Library  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2758-9041","authenticated-orcid":false,"given":"Lara","family":"Wadi","sequence":"additional","affiliation":[{"name":"Department of Neurology Duke University Medical Center  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Ho","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6064-1529","authenticated-orcid":false,"given":"Birgit","family":"Frauscher","sequence":"additional","affiliation":[{"name":"Department of Neurology Duke University Medical Center  Durham NC USA"},{"name":"Department of Biomedical Engineering Duke Pratt School of Engineering  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"EngelF.Definition of the postictal state: when does it start and end?2010."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16519"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2010.06.039"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1684\/epd.2022.1430"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000103490.49537.37"},{"key":"e_1_2_7_7_1","volume-title":"Recherches sur les sympt\u00f4mes et le traitement de l'\u00e9pilepsie h\u00e9mipl\u00e9gique. 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