Objective      To investigate the clinical factors associated with postictal generalized EEG suppression (PGES) after generalized convulsive seizures (GCS) through analyzing clinical and video-electroencephalography (VEEG) data in patients with refractory epilepsy.       Methods      The clinical data and VEEG records of 96 GCS in 57 patients

who were monitored in our neurosurgery department from September 2010 to July 2015

were retrospectively reviewed. Differences of sex

age

aetiology

seizure focus

seizure frequency

seizure type of semiology

seizure duration

stage of wakefulness

and administration of oxygen between patients with PGES and patients without PGES were systematically analyzed. Enumeration data were assessed by Chi square test and measurement data were assessed by Mann-Whitney U test.       Results      PGES was observed in 36 (37.5%) patients and 24 (42.1%) GCSs. The duration of PGES was 45.4±38.5 s. The incidence of PGES in the temporal lobe epilepsy was higher than that outside the temporal lobe epilepsy (70.6% vs 26.7%

P=0.03). The incidence of PGES in tonic-clonic GCS with bilateral and symmetric tonic arm extension was higher than that in clonic GCS without tonic arm extension or flexion and that in GCS with unilateral or asymmetric tonic arm extension or flexion (48.2% vs 13.3% vs 28.0%

P=0.02). The incidence of PGES in GCS during asleep period was higher than that during awake period (47.1% vs 26.7%

P=0.04). The incidence of PGES in unconsciousness or motionlessness was higher than that in consciousness or free movement at seizure ends (45.6% vs 0

P0.01). The incidence of PGES after early administration of oxygen was lower than that not giving oxygen at seizure onset. (20.6% vs 46.8%

P=0.01). The mean duration of tonic phase of GCS with PGES was higher than that without PGES (10.7±6.6

vs 7.7±2.1 s

P=0.03). No statistical difference was observed in the other variables such as sex

age

aetiology and seizure frequency.       Conclusion      The incidence of PGES is more frequent in the temporal lobe epilepsy

tonic-clonic GCS with bilateral and symmetric tonic arm extension

GCS during asleep period

and unconsciousness or motionlessness at seizure ends. Early administration of oxygen can prevent the incidence of PGES.