Todd's paralysis

Definition

Todd's palsy is a transient condition that develops after an epileptic seizure. Patients experience paresis or paralysis of the limbs on one side or both. Such paralysis is the first warning of exhaustion of the nervous system and may be a symptom of cancer or metabolic disorders.

Paralysis can be diagnosed only after magnetic resonance imaging, which will rule out cerebral circulatory disorders and organic damage to nervous tissue. Additionally, the doctor may prescribe electroencephalography (EEG) to identify foci of epilepsy, Dopplerography of cerebral vessels, angiography and other tests.

If the cause of the seizures is not found, then treatment is reduced to stopping the epilepsy.

Diagnosis of Todd's palsy

The presence of epilepsy and a history of previously manifested postictal paresis indicate postepileptic paralysis. Differential analysis is necessary to distinguish primary paralysis after an epileptic seizure from acute cerebrovascular accident.

An emergency MRI or CT scan of the brain is necessary. Research data will also exclude brain tumors, encephalitis, and hydrocephalus. If organic brain lesions are not confirmed, it is necessary to monitor the patient over time. The diagnosis of Todd's palsy is confirmed when motor impairment resolves within 48 hours.

Additional diagnostic methods include angiography, MRI of cerebral vessels, and electroencephalography. To assess the condition of the internal organs, an ultrasound of the heart, an electrocardiogram, and a biochemical blood test are performed. To clarify the conclusion, you may need to consult related specialists - a cardiologist, an endocrinologist.

Causes

Todd's paralysis remains one of the medical mysteries. And without knowing the cause, doctors cannot develop a mechanism for dissociating the pathological process in order to cure it. Based on indirect evidence, doctors have several assumptions regarding the nature of the disease. According to the most progressive theory, the “phenomenon of inhibition of the nervous system” manifests itself in the form of paralysis. It is associated with impaired neurotransmitter transmission.

In addition, there are several other reasons:

- several epileptic seizures in a row; - brain exhaustion; - malignant neoplasm of the central nervous system; - inflammation of the brain substance, especially of viral etiology; — uncoupling of lipid metabolism; - presence of ischemic strokes in the past; - diseases of the heart and blood vessels.

Causes of pathology

Todd's palsy is a direct consequence of epilepsy. Such paresis develops as a result of depletion of the central nervous system and an imbalance between the processes of excitation and inhibition. The exact cause that provokes the development of such paresis has not yet been determined, but the most likely hypothesis is the exhaustion of the nervous system. This can also explain the fact that the first symptoms of Todd's paralysis are detected in childhood, when the child's nervous system is highly susceptible to any negative influences due to the fact that it is not fully formed.

Possible causes of Todd's paralysis include:

• epilepsy;
• CNS depletion;
• tumor diseases of the brain;
• encephalitis that develops as a result of infection by the herpes virus;
• vascular ischemia.

All these reasons have one thing in common - a shift in the balance of nervous system processes towards inhibition.

Symptoms

How does Todd's paralysis manifest itself? The symptoms initially resemble those of an epileptic seizure. For those around you, watching an attack can be quite difficult, since they have no opportunity to help the patient. But even after the cramps end, the person cannot fall asleep and experience blissful oblivion. On the contrary, he freezes and cannot move his arms and legs.

How long will Todd's paralysis last? Symptoms (photos of patients can be traumatic and are considered unethical) sometimes persist around the meshes or more. Doctors most often note the appearance of unilateral paralysis or paresis. Over time, the motor blockade passes without leaving any consequences. Medical periodicals record cases of Todd's paralysis with visual and articulation impairments.

At the first encounter with this pathology, the symptoms can be regarded as manifestations of a stroke, but after all the necessary diagnostic measures have been carried out, the primary diagnosis is removed, and the rapid regression of symptoms confirms the version of paralysis.

Symptoms of pathology

After an epileptic seizure, patients experience convulsive conditions. The main symptom of Todd's paralysis is the absence of voluntary motor activity after a seizure for the next two days, but the duration of paralysis can vary. Todd's paralysis is also accompanied by a decrease in muscle activity and reflex activity. Paresis is usually asymmetrical and affects only one side of the body.

Restoration of muscle function occurs without specific therapy, independently. The duration of this condition can vary from several hours to two days, after which muscle activity gradually increases until it returns to normal.

Rare symptoms of Todd's paralysis include blurred vision and speech problems. These conditions are often confused with a stroke.

Diagnostics

What should be done to confirm Todd's paralysis? The signs of the disease are quite vague. It is necessary to exclude all other pathologies to be sure of the diagnosis. The first step is to determine the severity of the observed condition and the level of muscle paralysis. To do this, conduct a physical examination and compare the data obtained with a five-point scale:

1. Five points means a complete absence of symptoms, the patient’s muscles are in a state of physiological norm.
2. Four points – strength indicators are slightly reduced, but the activity of the limbs is still maintained. The patient calmly overcomes the resistance of the doctor's hand.
3. Three points - stiffness of the victim’s muscles is noticeable to the naked eye, but the patient is still able to make voluntary movements, although not as quickly as with four points. It becomes more difficult to overcome the resistance of the doctor's hand.
4. Two points - the Earth's gravity becomes an insurmountable obstacle for such a patient.
5. One point – complete muscle paralysis is observed.

After the examination, the doctor collects a thorough history from the patient’s relatives, studies the medical record, and prescribes a computed tomography or magnetic resonance imaging scan. To exclude a stroke, the patient undergoes angiography to identify the focus of epilepsy (if there is a history of one), and electroencephalography is prescribed. To determine concomitant pathologies, ultrasound examination of the heart and electrocardiography are performed.

Only having all the results, the doctor can choose the most probable one among all the possible diagnoses and begin therapy.

Diagnosis of pathology

Manifestations of Todd syndrome are symptomatically similar to stroke. They are accompanied by partial or complete paralysis of muscles, problems with speech and focusing of gaze. This causes difficulties in diagnosing the pathology.

Diagnosis is facilitated by a history of epilepsy. The diagnosis is made only after assessing the level of muscle stiffness and weakening. This is done by examining the patient; also, to assess muscle strength, the doctor observes the resistance of the affected limb to external pressure. This requires a physical examination, which evaluates the condition of the muscles on a five-point scale:

• 5 – muscles are normal, no paresis;
• 4 – reflexes are normal, muscles are not weakened enough;
• 3 – motor impairments are visible visually;
• 2 – muscles are weak, it’s impossible to even raise your arm;
• 1 – motor activity is almost completely absent;
• 0 – complete paralysis of muscles.

Magnetic resonance imaging of the brain is mandatory to exclude vascular ischemia. To rule out a stroke, it is necessary to do a CT scan of the brain, which allows one to detect foci of hemorrhage if they are present.

It is necessary to examine the activity of the brain and exclude heart pathologies.

Treatment

How can Todd's paralysis be reversed? The treatment, although purely symptomatic, has low effectiveness, since it is difficult to accurately establish the cause of this condition. Therapy depends on the level and severity of paralysis.

If movement disorders are minor, then specific treatment is not required. The symptoms will go away on their own within a few hours or days. For more profound disorders, benzodiazepine drugs are used, such as Midazolam, Diazepam, Lorazepam, Fosphenytoin or Phenytoin. Each of them stops convulsive attacks and their consequences. When prescribing them, it is necessary to remember that abrupt withdrawal of antiepileptic drugs can also provoke an attack.

There are contraindications for prescribing these drugs. First of all, this is, of course, intolerance to the components of the drug, as well as a history of closed-angle glaucoma and drug or alcohol addiction. In addition, renal function plays an important role, since the drug is mainly excreted in the urine.

Prevention

There is no way to prevent Todd's post-seizure paralysis. This condition has not yet been fully studied, so specific prevention, as well as treatment, cannot be developed. Perhaps some time later, when the capabilities of medicine become even greater, we will be able to take some steps to eliminate this pathology.

Today, doctors give very vague advice, such as maintaining a healthy lifestyle, proper nutrition, giving up bad habits and moderate physical activity. In addition, you should not forget about periodic preventive examinations, because any disease is easier to prevent than to treat.

Forecast

Todd's palsy can have a good or bad prognosis. It all depends on the severity of neurological symptoms and the duration of paresis or paralysis. If a neurologist gives a rating of “three” or “four” on a five-point scale, then in this case the disease does not cause significant concern, and the prognosis for life and health is favorable. The body quickly recovers after attacks; the condition does not require drug intervention.

If the paralysis lasts a long time, the functions of the limbs are restored for a long time, and the number of attacks becomes more frequent over time, then the prognosis for life is, of course, unfavorable.

Latest research

Right- and left-sided Todd's palsy can progress, and over time muscle weakness remains, even after long-term treatment. For such patients, as well as other paralyzed people, science has a couple of revolutionary ideas to offer. The first of these is the creation of prosthetics. Today, there are prototypes of bionic limbs controlled by the power of thought, that is, the device connects to the nervous system and perceives nerve impulses, deciphering the signals.

The second method is rather biological. It is based on the restoration of nerve endings using stem cells. Since they have a tendency to almost endless division, and can also differentiate into any cell of the human body. Experiments are currently being carried out on laboratory animals, but if they are successful, one can hope for a significant breakthrough in the treatment of neurological diseases.