Todd's palsy symptoms, causes, treatment

The Todd's paralysis it is a type of postcritical or postictal paralysis that follows some types of seizures. It is usually described as a motor deficit that affects the efficient movement of various muscle groups. It can cause alterations in both the left and right hemibody and is related to the movement of the upper and lower extremities..

In most cases, the etiological origin of Todd syndrome is found in the suffering of generalized clinical tonic seizures. As the specialists Sánchez Flores and Sosa Barragán point out, the diagnosis of this pathology is usually made based on exclusion through the identification of various clinical criteria.

There is no specific medical intervention for Todd syndrome. Treatment is usually aimed at controlling seizures. However, the use of some type of physical therapy for muscular sequelae is frequent..

Article index

• 1 History
• 2 Characteristics of Todd's palsy
• 3 Is it a frequent pathology?
• 4 Symptoms
  • 4.1 Other signs and symptoms
• 5 Clinical course
• 6 Causes
• 7 Diagnosis
• 8 Treatment
• 9 References

Story

This syndrome was initially described by Todd in 1854. The researcher Robert Bentley Todd, a native of Dublin, settled in London where he achieved numerous successes associated with the area of ​​medicine and education..

Initially, he characterized this syndrome as a type of motor disorder that appeared after the presence of certain types of epileptic seizures, especially those that presented a motor or generalized course.

Thus, in the first moments, Todd syndrome was called epileptic paralysis or postictal paralysis..

The term ictal period is used in the medical and experimental field to refer to an abnormal state that occurs between the end of a seizure and the beginning of recovery from baseline or initial state. It is in this phase where the clinical characteristics of Todd's syndrome or paralysis are found..

Characteristics of Todd's palsy

Todd's syndrome or paralysis is described as a neurological disorder commonly experienced by some people with epilepsy. Specifically, it consists of a temporary muscle paralysis that follows a period of attack or seizure..

Epilepsy is one of the most serious and frequent neurological diseases in the general population. Data published by the World Health Organization (2016) indicates that there are more than 50,000 million people with a diagnosis of epilepsy worldwide.

Its clinical course derives from the presence of abnormal and / or pathological neuronal activity that results in the suffering of recurrent seizures or seizures.

Seizures may be characterized by an exaggerated increase in muscle tone, the development of strong muscle jerks, loss of consciousness, or episodes of absences..

The sequelae of this type of pathological event will depend fundamentally on the complexity and associated brain areas. It is possible to appreciate manifestations of a positive nature (behavioral, visual, olfactory, taste or auditory) and alterations of a negative nature (aphasic, sensory or motor deficits).

Is it a frequent pathology?

Todd's palsy is considered a rare neurological disorder in the general population and especially in adults. International clinical reports indicate a higher prevalence associated with the pediatric population with epilepsy.

Various clinical studies, as referenced by the authors Degirmenci and Kececi (2016) indicate that Todd's palsy has an approximate prevalence of 0.64% of the patients with epilepsy examined.

Symptoms

The clinical course of Todd syndrome is fundamentally related to the appearance of various motor deficits, paresis, and paralysis..

The term paresis is often used to refer to a partial or complete deficit of voluntary movements. Generally, it is not usually complete and the efficient functioning of the extremities is associated.

Parasia usually has a unilateral presentation, that is, it affects one of the body halves and is associated with the motor areas affected by epileptogenic discharge. This being the most frequent, it is also possible that it appears:

• Monoparesis: partial absence of movement tends to affect only one limb, upper or lower.
• Facial paresis: partial absence of movement tends to preferentially affect the craniofacial areas.

For its part, paralysis refers to the complete absence of movement relative to various muscle groups, either at the facial level or specifically in the extremities..

Both findings are of great clinical relevance due to both the functional limitation that sometimes occurs and the consequent concern.

Other signs and symptoms

In some patients in adulthood, Todd's phenomenon has to take a clinical form associated with focal neurological deficits:

• Aphasia: secondary to muscle paralysis and / or involvement of neurological areas responsible for language control, the affected person may have difficulty or inability to articulate, express or understand language.
• Visual loss: a significant loss of visual acuity can be identified associated with an involvement of the sensory cortical regions or various problems associated with the position of the eyes and ocular paralysis.
• Somatosensory deficit: some alterations may appear associated with the perception of tactile, painful stimuli or the position of the body.

Clinical course

The classic presentation of Todd syndrome is located after suffering a generalized tonic-clonic seizure. Tonic-clonic seizures are defined by an onset associated with the development of exaggerated and generalized muscle rigidity (tonic crisis).

Subsequently, it results in the presence of multiple uncontrollable and involuntary muscle movements (clonic crisis). After this type of convulsive crisis, the onset of Todd syndrome can be identified by the development of significant muscle weakness in the legs, arms, or hands..

Muscle alteration can vary, taking the form of paresis in some mild cases and complete paralysis in other more serious cases..

The duration of the Todd phenomenon is short. Symptom presentation is unlikely to exceed 36 hours. The most common is that this type of paralysis has an average duration of 15 hours.

The persistence of these symptoms is usually associated with structural injuries resulting from cerebrovascular accidents. Despite this, in the medical literature we can identify some cases with a duration of up to 1 month. These are usually associated with biochemical, metabolic and physiological recovery processes..

Causes

A large part of the identified cases of Todd's paralysis are associated with seizures as a result of suffering from primary epilepsy. However, there are also other types of pathological processes and events that can give rise to the presentation of seizures of a tonic-clonic nature:

• Infectious processes.
• Head injuries.
• Strokes.
• Genetic alterations.
• Congenital brain malformations.
• Brain tumors
• Neurodegenerative diseases
• Inflammatory processes at the brain level.

Diagnosis

In the diagnosis of Todd syndrome, the physical examination, the analysis of the medical history and the study of the primary seizures are essential. Additionally, the following clinical criteria are usually used to confirm the diagnosis:

• History or immediate presence of seizures. They are especially associated with generalized tonic-clonic seizures..
• Identification of hemiparesis or hemiplegia, paresis or paralysis.
• Variable presence of visual disturbances after the development of the seizure.
• Complete remission of the clinical course in a period of 48 to 72 hours.
• Absence of specific alterations at the structural level examined through imaging tests.
• Normal EEG.

In these cases, it is essential to identify the etiological cause of the seizures since they can be a direct indicator of a serious pathological process that puts the survival of the affected person at risk..

Treatment

There is no specifically designed treatment for Todd syndrome. Most commonly, medical intervention focuses on treating the etiological cause and controlling the seizures. First-line treatment in severe seizures is anticonvulsant or antiepileptic drugs.

Additionally, it is beneficial to include the affected person in a physical rehabilitation program to improve the disorders associated with muscle paralysis and achieve an optimal functional level..

References

1. Degirmenci, Y., & Kececi, H. (2016). Prolonged Todd Paralysis: A Rare Case of Postictal Motor Phenomenon. Immedpub journals.
2. Epilepsy Foundation. (2016). Todd's Paralysis. Obtained from Epilepsy Foundation.
3. Fernández Torrón, R., Esteve Belloch, P., Riverol, M., Palma, J., & Iriarte, J. (2012). Prolonged hemiplegia as the sole symptom of a simple focal non-convulsive status epilepticus. Rev Neruology.
4. NIH. (2011). Todd's Paralysis. National Institute of Neurological Disorders and Stroke.
5. WHO. (2016). Epilepsy. Obtained from World Health Organization.
6. Well Alonso, A. (2005). Focal epilepsy in the nile and Todd's palsy: experience of 11 cases. Rev Cuabana Pediatr.
7. Sánchez Flores, H. (2011). Todd's paralysis. Mexico Emergency Medicine Archive.
8. Urrestarazu, E. (2002). Postcritical paresis during video-EEG monitoring studies. Rev Neurol.