Clinical Lectures on Paralysis, Diseases of the Brain, and other Affections of the Nervous System

Todd, Robert B.

doi:10.1097/00000441-185601000-00017

Cited by 42 publications

(47 citation statements)

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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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“…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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“…This transient lesion led to the production of both positive and negative symptoms (27). Negative symptoms included the paralysis noted by Robert Todd years earlier (58) and, in severe cases, coma. Jackson proposed that if the first layer of the highest center were to discharge, its exhaustion would lead to "dissolution" of the second layer, which would remain active and would be expressed due to its loss of inhibition or modulation by the higher layer.…”

Section: Postictal Psychosis (Aka Epileptic Mania)mentioning

confidence: 98%

Epilepsy and Behavior: A Brief History

Masia¹,

Devinsky²

2000

Epilepsy & Behavior

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“…16 In London Robert Bentley Todd employed it in a patient with epileptic seizures in 1852, several years before Locock used it. 17 Todd's patient had gout secondary to leadinduced nephropathy, was in terminal renal failure and died too soon after commencing bromide intake to permit conclusions regarding its efficacy. Todd did not indicate his rationale for using the drug.…”

Section: Potassium Bromide Before Locockmentioning

confidence: 99%

Sir Charles Locock and potassium bromide

Eadie¹

2012

J R Coll Physicians Edinb

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Clinical Lectures on Paralysis, Diseases of the Brain, and other Affections of the Nervous System

Cited by 42 publications

References 0 publications

Postictal Nosewiping Lateralizes and Localizes to the Ipsilateral Temporal Lobe

Postictal Nosewiping Lateralizes and Localizes to the Ipsilateral Temporal Lobe

Epilepsy and Behavior: A Brief History

Sir Charles Locock and potassium bromide

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