From the Guidelines
Todd paresis is a temporary condition that resolves spontaneously within 24-48 hours and does not require specific treatment, but rather management of the underlying seizure disorder with antiepileptic medications as prescribed by a neurologist. This condition is characterized by weakness or paralysis in a part of the body following a seizure, typically affecting the limbs on one side of the body. According to a prospective cohort study by Hauser et al 1, Todd’s paralysis did predict recurrence of seizures, with a recurrence rate of 76%. The management of Todd paresis focuses on treating the underlying seizure disorder, and patients should rest in a safe position and be monitored until symptoms resolve. It is crucial to distinguish Todd paresis from a stroke, which can present similarly but requires immediate medical intervention.
Some key points to consider in the management of Todd paresis include:
- The condition is temporary and resolves spontaneously
- No specific medication is required to treat Todd paresis itself
- Management focuses on treating the underlying seizure disorder with antiepileptic medications
- Patients should rest in a safe position and be monitored until symptoms resolve
- It is crucial to distinguish Todd paresis from a stroke, which requires immediate medical intervention.
A meta-analysis by Berg and Shinnar 1 found that increased risk of seizure recurrence was associated with abnormal neurologic examination and abnormal EEG, with a 36% seizure recurrence rate at 2 years in prospective studies. However, the study by Hauser et al 1 provides more specific information on Todd paresis, making it a higher priority for guiding management decisions.
In terms of specific antiepileptic medications, the choice should be made by a neurologist based on the specific seizure type and patient factors, and may include medications such as levetiracetam, carbamazepine, or lamotrigine. A randomized, multicenter trial by the FIRST Group 1 found that treatment with antiepileptic medications reduced the risk of seizure recurrence, but the study did not specifically address Todd paresis.
Overall, the key to managing Todd paresis is to focus on treating the underlying seizure disorder, while also providing supportive care and monitoring during episodes of Todd paresis.
From the Research
Definition and Characteristics of Todd Paresis
- Todd paresis, also known as Todd's phenomenon, is a focal weakness in a part of the body after a seizure 2.
- It is a transitional period from the ictal state to the pre-seizure baseline level of awareness and function, referred to as the postictal period 2.
- Postictal symptoms include many systems, including sensory, motor, and psychosis 2.
Clinical Manifestations and Diagnosis
- Todd's paresis can be confused with other conditions, most commonly a stroke 2.
- Postictal ocular manifestation may be accompanied by aphasia or hemiplegia, but isolated gaze palsy is rarely reported 2.
- Patients with an underlying structural abnormality of the brain are more susceptible to Todd's phenomenon 2.
- Unusual manifestations of Todd's phenomenon are rare but clinically relevant and are decisive in therapeutic decision-making 2.
Treatment and Management
- There is no specific treatment for Todd's paresis, but it usually resolves on its own within a few hours to days 3.
- Antiepileptic drugs may be used to manage seizures and prevent further episodes of Todd's paresis 4, 5.
- In some cases, surgery may be necessary to remove the underlying cause of the seizures, such as a brain lesion 3, 6.
Prognosis and Outcome
- The prognosis for Todd's paresis is generally good, with most patients experiencing complete resolution of symptoms within a few hours to days 3.
- However, some patients may experience recurrent episodes of Todd's paresis, especially if the underlying cause of the seizures is not addressed 2, 3.
- In rare cases, Todd's paresis can be a sign of an underlying neurological condition, such as a brain tumor or stroke, which requires prompt medical attention 2.