Todd's paralysis: what is it, causes, symptoms, treatment, prognosis

What is Todd's palsy?

Todd's paralysis (postictal paralysis) is a neurological condition experienced by patients suffering from epilepsy, in which the attack is accompanied by short-term paralysis. Paralysis can be partial or complete, but it usually occurs on only one side of the body. Paralysis can last from half an hour to 36 hours, an average of 15 hours, after which it completely goes away. Todd's palsy can also affect speech and vision.

Scientists don't know what causes Todd's paralysis. Current theories suggest biological processes in the brain that involve slowing down the production of energy by neurons or motor centers in the brain. It is important to distinguish Todd's palsy from strokewhich it may be like as a stroke requires a completely different treatment.

The disorder was originally described by Irish physiologist Robert Bentley Todd in 1849, but these years the condition was additionally determined, investigated and explained by many others doctors-scientists. Although this disorder is common in neurologists, relatively little research has been done on the condition.

Signs and symptoms

Todd's palsy is a heterogeneous clinical syndrome involving many unilateral focal neurological disorders that occur on the side of the body opposite the focus of the seizure, for example:

• paresis;
• aphasia;
• gaze paralysis;
• sensory impairment.

These clinical signs appear immediately after an attack, and most episodes of Todd's palsy are short-lived, with one study showing that clinical signs lasted, on average, about three minutes. The duration may be longer in patients with tonic-clonic generalized seizures compared with patients with focal seizures.

This is in contrast to seizures after stroke, which show focal neurological defects of long duration, depending on the severity of the stroke. Indeed, in patients with Todd's palsy, ongoing focal neurological deficits for more than a few minutes are usually indicates the presence of focal brain damage as the main etiology of seizures or persistent non-convulsive seizures.

Causes and risk factors

The exact cause of Todd's paralysis remains unclear. Scientists in the field of medicine and physiology have identified the relationship of post-epileptic motor disorders with immoderately progressive processes of inhibition, originating in the central nervous system.

Paralysis is the result of neurotransmitter failure and weakening of brain function. This statement is not without foundation, since Todd's paralysis in most cases is recorded when:

• organic diseases of the brain - encephalitis;
• cerebral circulation disorders;
• tumors of the central nervous system (CNS);
• severe primary diseases - liver failure, chronic renal failure, heart failure, diabetes mellitus, tuberculosis, septic conditions.

The paralytic state is caused by dysmetabolic, ischemic and toxic effects on the central nervous system. Todd's paralysis usually occurs after an epileptic seizure that lasts more than half an hour. Laboratory studies show that lipid metabolism is disturbed in patients, the content of triglycerides increases, and cholesterol saturation decreases.

Epidemiology

About 13% of all seizures show signs of Todd's palsy in some form. The condition has no gender tendency and can occur at any particular age or race.

Diagnostics

Availability epilepsy, previously manifested postictal paresis in the anamnesis indicate post-epileptic paralysis. Differential analysis is necessary to distinguish primary paralysis after an epileptic seizure from acute cerebrovascular accident.

An emergency magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain is required. Research data will also exclude brain neoplasms, encephalitis, hydrocephalus. If organic lesions of the brain are not confirmed, it is necessary to monitor the patient in dynamics. The diagnosis of Todd's palsy is confirmed when the motor impairment resolves within 48 hours.

As additional diagnostic methods, angiography, MRI of cerebral vessels, and electroencephalography are prescribed. To assess the condition of the internal organs, an ultrasound examination (ultrasound) of the heart, an electrocardiogram, and a biochemical blood test are performed. To clarify the conclusion, you may need to consult related specialists - a cardiologist, an endocrinologist.

Treatment

In the treatment of postictal paralysis, the basis is the appointment of antiepileptic drugs - anticonvulsants. With their help, they stop and reduce the frequency of epileptic seizures. The drugs are prescribed only by an epileptologist - phenytoin, diazepam, lorazepam, valproic acid. Diseases of internal organs, metabolic disorders require the appointment of drug treatment and correction.

If no central nervous system disease is identified, no additional treatment for paralysis is performed. With hydrocephalus, diuretics and drugs containing potassium are prescribed. If tumors are found on CT and MRI scans, a neurosurgeon's consultation is necessary to consider the issue of surgical treatment.

Forecast

Patients who have survived Todd's palsy are expected to regain sensitivity in the affected parts of the body. If the seizure is severe, there may be persistent symptoms due to the effects of the seizure on the brain. These side effects are seizure-related and are not the result of Todd's palsy. A neurologist specializing in epilepsy will be able to assess how severe the seizure was, whether seizures should be expected to continue, and whether anticonvulsants should be taken.

Complications

No complications are expected as the paresis goes away on its own. Rarely, some patients undergo unnecessary procedures if a diagnosis is not made.