Todd's Paralysis

Todd's paralysis

1. Ade Wijaya , MD – May 2021 Todd's Paralysis

2. Outline: History Epidemiology Clinical Manifestation Pathophysiology Diagnosis Summary

3. History Binder DK. A history of Todd and his paralysis.  Neurosurgery.  2004;54(2):480–86. discussion 486–87. Todd RB, Schlesinger EB.  Clinical lectures on paralysis, disease of the brain, and other affections of the nervous system.  Philadelphia: Lindsay & Blakiston ; 1855.

4. Epidemiology Todd’s paralysis is commonly observed after partial seizures or generalized tonic- clonic seizures (GTCS ) Incidence: 0.6-13.4 % (greater in structural damage) Risk factors: Convulsive status epilepticus (CSE), prolonged seizures, and high scores on the Glasgow Coma Scale (GCS)  Werhahn KJ. Weakness and focal sensory deficits in the postictal state.  Epilepsy Behav .  2010;19(2):138–39.  Kellinghaus C, Kotagal P. Lateralizing value of Todd’s palsy in patients with epilepsy.  Neurology.  2004;62(2):289–91.  Rolak LA, Rutecki P, Ashizawa T, Harati Y. Clinical features of Todd’s post-epileptic paralysis.  J Neurol Neurosurg Psychiatry.  1992;55(1):63–64

5. Clinical Manifestation Upper and lower limbs in 50% of cases Face and the upper and lower limbs in 21.4% of cases Only the upper limbs (14.2%) Only the lower limbs (7.1%) Face and upper limbs (7.1 %) Duration: 0.5–36 hours, with an average of 15 hours Rolak LA, Rutecki P, Ashizawa T, Harati Y. Clinical features of Todd’s post-epileptic paralysis.  J Neurol Neurosurg Psychiatry.  1992;55(1):63–64.

6. Pathophysiology Blood flow reduction - Seizure  ↑ prostaglandin  vasoconstriction  elevated free calcium concentrations in vascular smooth muscle Sharp increase in metabolic activity and peripheral neuronal failure Increased inhibitory activity in brain regions regulating movement. Xu , S. Y., Li, Z. X., Wu, X. W., Li, L., & Li, C. X. (2020). Frequency and Pathophysiology of Post-Seizure Todd's Paralysis.  Medical science monitor : international medical journal of experimental and clinical research ,  26 , e920751. https://doi.org/10.12659/MSM.920751

7. Diagnosis Clinical diagnosis When CT perfusion abnormalities occur in atypical vascular distributions, and the CT angiography shows no corresponding large-vessel occlusions, Todd’s paralysis should be considered prior to acute stroke    Gelfand JM, Wintermark M, Josephson SA. Cerebral perfusion-CT patterns following seizure.  Eur J Neurol.  2010;17(4):594–601.

8. Summary Commonly observed after partial seizures or GTCS. The incidence is greater if the epilepsy is associated with old age or stroke history. The duration can range from minutes to days, depending on the type of seizure or whether the patient has experienced cortical structural damage. The etiology is associated with cerebral perfusion abnormality after seizures.

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