From the Guidelines
Todd's Syndrome, also known as Todd's paralysis, is a neurological condition characterized by a temporary weakness or paralysis of a part of the body following a seizure, which can be mistaken for a stroke due to similar symptoms. This condition is often discussed in the context of distinguishing it from ischemic stroke, particularly when seizures occur at the onset of a stroke, making diagnosis challenging 1. The symptoms of Todd's Syndrome can include weakness, numbness, or paralysis of a limb, which typically resolve within 24 to 48 hours. It is crucial to differentiate Todd's Syndrome from ischemic stroke because the treatment approaches are vastly different, with stroke often requiring immediate thrombolytic therapy, which may not be appropriate for patients with Todd's Syndrome due to the risk of hemorrhage 1.
Key Characteristics and Diagnosis
- Todd's Syndrome is a transient condition, usually resolving on its own within a short period.
- It can affect any part of the body but often involves limbs.
- Diagnosis is primarily clinical, relying on the history of a recent seizure and the presence of focal neurological deficits that are transient.
- Advanced imaging techniques like magnetic resonance diffusion and perfusion-weighted images, angiography, perfusion CT, or CT angiography can help differentiate Todd's Syndrome from an ischemic stroke when the diagnosis is uncertain 1.
Management and Treatment
- The management of Todd's Syndrome focuses on treating the underlying cause, such as seizures, and providing supportive care.
- Since the condition is temporary and resolves spontaneously, the mainstay of treatment is often supportive and aimed at preventing further seizures if epilepsy is the underlying cause.
- In some cases, particularly if the syndrome is associated with migraines or other conditions, treating the underlying condition can help prevent future episodes of Todd's Syndrome.
From the Research
Definition and Characteristics of Todd's Syndrome
- Todd's paralysis, also known as Todd's syndrome, is a neurological abnormality characterized by temporary limb weakness or hemiplegia, typically occurring following a seizure, without enduring consequences 2.
- It is often difficult to diagnose Todd's paralysis in individuals experiencing an acute ischemic stroke if they do not have a pre-existing history of epilepsy 2.
- 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.
Clinical Manifestations and Diagnosis
- 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.
- Todd's paralysis occurs after 6-13% of seizures, and the symptoms may last from minutes to 36 hours 3.
- The use of advanced imaging such as cerebral CT and MRI with angiography is recommended to differentiate Todd's paralysis from other clinical indications, such as stroke with seizure at symptom onset 3.
Distinction from Other Conditions
- Todd's paralysis can be distinguished from other clinical indications by considering factors such as the type of seizure, age, and stroke history 2, 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 2.