Clinical features of Todd's post-epileptic paralysis.

Rolak, Loren A.; Rutecki, Paul; Ashizawa, T; Harati, Yadollah

doi:10.1136/jnnp.55.1.63

Cited by 99 publications

(65 citation statements)

References 12 publications

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“…The duration of TP is generally considered to be short which can persist from half an hour to 36 hours, with a mean duration of 15 hours, and never persisted far beyond [3], whereas a longer duration was reported in stroke patients with a structural lesion in the seizure-generating hemisphere [1]. In contrast with the literature knowledge, we here reported a patient with prolonged TP which lasted a month, without any underlying acute structural or vascular lesion in brain.…”

Section: Discussioncontrasting

confidence: 71%

“…Despite the literature knowledge reporting the duration of TP as half an hour to 36 hours [3], we shared this case of TP which persisted 1 month after the cessation of seizures without any underlying acute cerebrovascular or structural lesions. This prolongation in paralysis may be related to the duration of the metabolic, biochemical and/or physiological recovery processes.…”

Section: Discussionmentioning

confidence: 65%

“…According to the literature knowledge, about 6% of patients who had tonicclonic seizures experienced TP [2]. The duration of TP may last from half an hour to 36 hours, and it is not found to be related with neither the etiology nor the seizure itself [3]. On the other hand, more prolonged postictal paralysis can occur, especially in patients with structural lesions such as tumor or stroke [4].…”

Section: Introductionmentioning

confidence: 99%

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Prolonged Todd Paralysis: A Rare Case of Postictal Motor Phenomenon

Değirmenci¹,

Kececi²

2016

J Neurol Neurosci

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Todd paralysis (TP) is a relatively rare postictal phenomenon characteristic with weakness of the limbs in various degrees, following epileptic seizures. Since it is a reversible phenomenon in general, the reported duration of TP varies between half-an-hour to 36 hours. However, there is limited data in the literature about TP which persists more than 36 hours. On this aspect, we presented this rare patient with epilepsy who was suffering from prolonged TP persisting since 1 month without any evidence of acute cerebrovascular or structural lesions.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

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Prolonged Todd Paralysis: A Rare Case of Postictal Motor Phenomenon

Değirmenci¹,

Kececi²

2016

J Neurol Neurosci

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“…Transient unilateral hemiparesis, or Todd's paresis, is probably the first described postictal clinical sign with lateralizing significance (24,25). However, it is rare in TLE (23).…”

mentioning

confidence: 99%

Postictal Nosewiping Lateralizes and Localizes to the Ipsilateral Temporal Lobe

Hirsch

Laín²,

Walczak

1998

Epilepsia

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Summary: Purpose:We observed many patients with temporal lobe epilepsy (TLE) wiping their nose postictally, usually with the hand ipsilateral to their seizure focus. We wished to determine if this had lateralizing or localizing significance.Methods: We retrospectively studied 87 patients: 47 with unilateral TLE defined by successful surgical outcome [30 with medial TLE (MTLE) and 17 with neocortical TLE (neoTLE)]; and 40 with extratemporal epilepsy (ExTLE). Videotapes of 319 complex partial seizures (CPS) without generalization were reviewed by 1 neurologist, blinded to patient identity, who recorded each episode of nosewiping and the hand with which it was performed.Results: With regard to localizing potential, postictal nosewiping (PINW) was significantly more common in patients with unilateral TLE than in those with ExTLE. In the TLE group, PINW within 60 s of electrographic seizure offset occurred in 60% of patients (28 of 47) and 43% of seizures (74 of 171). In the ExTLE group, PINW was noted in 33% of patients (13 of 40; p < 0.05 as compared with TLE) and 15% of seizures (22 of 148; p < 0.001). Similar results were obtained with PINW within 30 s of seizure offset. Although PINW was more frequent in MTLE than in neoTLE (67% of patients vs. 47%), this finding did not reach significance. With regard to lateralizing potential, in the TLE group, unilateral PINW (performed with a single hand only) within 60 s of seizure offset was observed in 53% of patients (25 of 47) and was performed with the hand ipsilateral to the seizure focus in 92% (23 of 25). Thirteen patients (9 with TLE) wiped their nose more than once with the same hand in a single seizure within 60 s of offset in 18 seizures; this was done with the hand ipsilateral to the seizure focus in all 18 instances (predictive value = 100%).Conclusions: PINW is more common in unilateral TLE, particularly MTLE, than in ExTLE. PINW performed exclusively with one hand occurs in -50% of patients with TLE and is highly predictive (92%) of seizure onset ipsilateral to the hand used, especially when it occurs repetitively. We hypothesize that ictal activation of the central autonomic nervous system, particularly the amygdala, results in ictal nasal secretions and causes nosewiping as the patient regains awareness postictally. The ipsilateral hand is used due to contralateral neglect or weakness. Key Words: Postictal nosewiping-Temporal lobe epilepsy-Semiology-Automatisms.Clinical behavior during epileptic seizures has intrigued neurologists for many years, and its study has led to the elucidation of many important clinicoanatomic correlations (1-8). The recent increase in epilepsy surgery and video/EEG (VEEG) monitoring has allowed careful study of ictal and postictal behavior in patients with well-defined seizure foci. Such studies have shown that certain features of epileptic seizures have localizing and lateralizing significance . This information is important in evaluation of patients for epilepsy surgery.Most attempts to correlate clinical behavior during compl...

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“…Todd's paralysis usually affects one or more limbs and its onset follows a focal seizure. Nevertheless, other neurological manifestations such as neglect, aphasia and psychosis can occur according to the focal area involved [1,2].…”

Section: Discussionmentioning

confidence: 99%

Nothing as it seems

Prado

Fiorelli

et al. 2013

Intern Emerg Med

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Case presentationDr. Tobaldini: An 82-year-old woman was brought by her daughter to the Emergency Department (ED) because she was found on the ground, confused, with right ocular deviation, dysarthria, left hemisoma hyposthenia, attention and executive functions' deficit.The past medical history was significant for Lewy bodies dementia and systemic hypertension. Her medications included quetiapina, selegina, zolpidem, escitalopram, acetylsalicylic acid, atenolol, enalapril and amlodipina.On admission to ED, the patient was confused and apyretic; blood pressure was 235/135 mmHg, SatO 2 97 % in ambient air, heart rate 95 beats/min, respiratory rate 26/min and plasma glucose 101 mg/dl. General physical examination revealed pulmonary bibasilar crackles. Neurological examination showed a left sided inattention, right ocular deviation, left partial vision paralysis, deficiency of the VII left cranial nerve, left hemisoma hyposthenia, positive Babinsky reflex on the left side, deep pain stimulus extinction on the left side; the NIH Stroke Scale (NIHSS) score was 11.Laboratory blood tests, ECG and a chest X-ray study were normal; the first brain CT-scan performed showed a past lacunar ischemia of the left thalamic region but it was negative for acute lesions.In the ED, the patient was treated with captopril and urapidil for blood pressure control; due to the patient's agitation, iv delorazepam was administered. The patient was admitted to internal medicine service.

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Clinical features of Todd's post-epileptic paralysis.

Cited by 99 publications

References 12 publications

Prolonged Todd Paralysis: A Rare Case of Postictal Motor Phenomenon

Prolonged Todd Paralysis: A Rare Case of Postictal Motor Phenomenon

Postictal Nosewiping Lateralizes and Localizes to the Ipsilateral Temporal Lobe

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