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This study assessed the prevalence of PIA, its associated clinical variables, and its relationship with quality of life (QoL), anxiety, and depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional study, consecutive patients with epilepsy (\u2265\u20091 seizure in the past 12\u00a0months; age\u2009\u2265\u200916\u00a0years) were surveyed using standardized questionnaires in a tertiary epilepsy center. Occurrence of PIA was retrospectively assessed over the preceding 12\u00a0months and defined by a score of \u2265\u20092 on the Overt aggression scale modified (OAS-M). Anxiety and depression were measured with the Hospital anxiety and depression scale (HADS-A, HADS-D) and the Neurological disorders depression inventory in epilepsy (NDDI-E).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 201 patients were included (57% male; median age 47\u00a0years; 76% focal epilepsy, 14% idiopathic generalized epilepsy (IGE), 10% unclassified). Twenty-four patients (12%) reported clinically relevant PIA. Patients with PIA had lower QoL (QOLIE-10 median 40 vs. 37, p\u2009=\u20090.031) and more frequent clinically relevant anxiety (HADS-A\u2009\u2265\u20098: 58% vs. 30%, p\u2009=\u20090.019). Depressive symptoms were more common in PIA (NDDI-E\u2009\u2265\u200916: 21% vs. 10%) without statistical significance (p\u2009=\u20090.309). IGE (OR 3.13, 95% CI 1.06\u20138.98) and anxiety (OR 2.51, 95% CI 1.02\u20136.26) were independently associated with PIA. There were no associations with antiseizure medications or their dosage. Ten patients reported adverse consequences of PIA, most commonly shame and fear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Almost one in eight patients experienced PIA. It was associated with reduced QoL and increased anxiety, highlighting the psychosocial burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-13796-z","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T15:43:10Z","timestamp":1775576590000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Postictal aggression in epilepsy: prevalence, clinical correlates, and psychosocial impact"],"prefix":"10.1007","volume":"273","author":[{"given":"Isabelle","family":"Herion","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6952-430X","authenticated-orcid":false,"given":"David","family":"Steinbart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desislava","family":"Dimova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2258-1670","authenticated-orcid":false,"given":"Martin","family":"Holtkamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"issue":"6","key":"13796_CR1","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1111\/epi.16519","volume":"61","author":"JCM Pottk\u00e4mper","year":"2020","unstructured":"Pottk\u00e4mper JCM, Hofmeijer J, van Waarde JA, van Putten M (2020) The postictal state - what do we know? 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The other authors report no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"We confirm that we have read the Journal\u2019s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. This study was carried out in accordance with the World Medical Association Declaration of Helsinki and it was approved by the Institutional Review Board of the Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin (EA2\/306\/20).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"254"}}