From the Guidelines
Todd's paralysis is a temporary and self-limiting neurological condition that occurs after a seizure, characterized by weakness or paralysis in a limb or one side of the body, and it is crucial to distinguish it from a stroke to avoid unnecessary thrombolytic therapy. This condition typically lasts from minutes to hours, rarely days, and resolves completely without specific treatment 1. The management of Todd's paralysis focuses on treating the underlying seizure disorder with appropriate antiepileptic medications, and during an episode, patients should be kept safe and monitored until symptoms resolve.
Key Characteristics of Todd's Paralysis
- Temporary neurological condition
- Occurs after a seizure
- Characterized by weakness or paralysis in a limb or one side of the body
- Typically lasts from minutes to hours, rarely days
- Resolves completely without specific treatment
- Requires distinction from stroke to avoid unnecessary thrombolytic therapy, as seen in the guidelines for intravenous alteplase for stroke 1
Management and Treatment
- Treatment of the underlying seizure disorder with antiepileptic medications
- Keeping patients safe during an episode
- Positioning unconscious patients on their side
- Monitoring until symptoms resolve It is essential to note that Todd's paralysis is caused by temporary neuronal exhaustion in the brain region affected by the seizure, leading to temporary dysfunction in the corresponding body area 1. Patients experiencing Todd's paralysis for the first time should seek medical evaluation to confirm the diagnosis and establish appropriate seizure management.
From the Research
Definition and Characteristics of Todd's Paralysis
- Todd's paralysis is a clinical entity consisting of acute focal neurological deficits following an epileptic seizure 2.
- It occurs after 6-13% of seizures, and the symptoms may last from minutes to 36 hours 2.
- The condition is characterized by temporary limb weakness or hemiplegia, typically occurring after a seizure, without enduring consequences 3.
Diagnosis and Differential Diagnoses
- Stroke with seizure at symptom onset is difficult to differentiate clinically from Todd's paralysis 2.
- The use of advanced imaging such as cerebral CT and MRI with angiography is recommended to aid in diagnosis 2.
- Old stroke is an independent risk etiology for Todd's paralysis, and patients with a history of old stroke are more likely to experience Todd's paralysis 4.
Clinical Features and Risk Factors
- Patients with Todd's paralysis are significantly older, more likely to have convulsive status epilepticus, and have a longer duration of convulsion than patients without Todd's paralysis 4.
- The incidence of Todd's paralysis is greater if the epilepsy is associated with old age or stroke history 3.
- 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 3.
Pathophysiology and Etiology
- The etiology of Todd's paralysis is associated with cerebral perfusion abnormality after seizures 3.
- Todd's paralysis is commonly observed after partial seizures or generalized tonic-clonic seizures 3.
- Further research is needed to explore factors that distinguish Todd's paralysis from other indications that may lead to limb weakness in order to improve the diagnosis of Todd's paralysis 3.