From the Guidelines
Todd's paralysis is a self-limiting condition that requires no specific treatment, with management focusing on the underlying seizure disorder and monitoring until symptoms resolve. This condition is characterized by temporary weakness or paralysis in a limb or one side of the body, typically lasting from minutes to hours, and sometimes days [ 1 ]. The phenomenon occurs due to temporary exhaustion or inhibition of neurons in the brain's motor cortex following the excessive electrical activity of a seizure. According to a prospective cohort study by Hauser et al [ 1 ], Todd's paralysis can predict seizure recurrence, with a recurrence rate of 76%. However, the primary concern is the underlying seizure disorder, and treatment should be focused on managing seizures with appropriate anticonvulsant medications prescribed by a neurologist.
Some key points to consider in the management of Todd's paralysis include:
- Resting in a safe position and monitoring until symptoms resolve
- Distinguishing Todd's paralysis from stroke, as the symptoms can appear similar
- Including information about Todd's paralysis in seizure action plans for patients with epilepsy
- Focusing on treating the underlying seizure disorder with anticonvulsant medications, as the recurrence rate is higher in patients with abnormal EEG and acute symptomatic seizures [ 1 ]. A meta-analysis by Berg and Shinnar [ 1 ] found that increased risk is associated with abnormal neurologic examination and abnormal EEG, with a 36% seizure recurrence rate at 2 years in prospective studies.
It is essential to seek medical attention for new-onset Todd's paralysis to rule out other conditions and to manage the underlying seizure disorder effectively. A randomized, multicenter trial by the FIRST Group [ 1 ] found that untreated patients had a 2.8 times higher risk of relapse, highlighting the importance of appropriate treatment and management.
From the Research
Definition and Characteristics of Todd's Paralysis
- Todd's paralysis is a neurological abnormality characterized by temporary limb weakness or hemiplegia, typically occurring following a seizure, without enduring consequences 2
- The condition is often difficult to diagnose in individuals experiencing an acute ischemic stroke if they do not have a pre-existing history of epilepsy 2
Factors that Distinguish Todd's Paralysis
- Todd's paralysis is commonly observed after partial seizures or generalized tonic-clonic seizures 2
- The incidence of Todd's paralysis is greater if the epilepsy is associated with old age or stroke history 2
- The duration of Todd's paralysis can range from minutes to days, depending on the type of seizure or whether the patient has experienced cortical structural damage 2
- The etiology of Todd's paralysis is associated with cerebral perfusion abnormality after seizures 2
Treatment and Management
- There is no direct evidence in the provided studies on the treatment and management of Todd's paralysis specifically 2, 3, 4, 5, 6
- However, studies on levetiracetam and phenytoin suggest that these medications may be used in the treatment of seizures and status epilepticus, which can be related to Todd's paralysis 3, 4, 5, 6
Related Conditions and Medications
- Status epilepticus is a neurologic emergency with potential for substantial mortality and morbidity, and levetiracetam may be used for SE that is refractory to benzodiazepine therapy 3
- Levetiracetam is as effective as valproic acid or phenytoin for the cessation of SE in adults, with a superior side-effect profile 3, 5
- Levetiracetam has a favourable safety profile in special populations, such as children, the elderly, and patients with hepatic dysfunction 6