The Todd's Palsy Is a type of postcritical or posttictal paralysis that follows some types of epileptic seizures (Urrestarazu, Iriarte, Alegre, Lázaro, Schlumberger, Artieda and Viteri, 2002).
It is usually described as a motor deficit that affects the efficient movement of various muscle groups (Pozo Alonso, Pozo Lauzán, Cordero López and Hernández Meilán, 2005).
It can cause alterations in both the left and right sides and is related to the movement of the upper and lower limbs (Pozo Alonso, Pozo Lauzán, Cordero López and Hernández Meilán, 2005).
In a large number of cases, the etiological origin of Todd syndrome is found in generalized convulsive seizures (Sánchez Flores and Sosa Barragán, 2011).
As the specialists Sánchez Flores and Sosa Barragán (2011) point out, the diagnosis of this pathology is usually made based on the exclusion through the identification of various clinical criteria.
There is no specific medical intervention for Todd syndrome. Treatment is usually directed to the control of seizures (Sánchez Flores and Sosa Barragán, 2011).
However, some kind of physical therapy is often used for muscular sequelae (Sánchez Flores and Sosa Barragán, 2011).
Characteristics of Todd's Palsy
Todd's syndrome or paralysis is described as a neurological disorder usually experienced by some people who suffer epilepsy (National Institute of Neurological Disorders, 2011).
Specifically, it consists of a temporary muscular paralysis that follows a period of attack or Seizures (National Institute of Neurological Disorders, 2011).
As we know, epilepsy is one of the most serious and frequent neurological diseases in the general population.
Data published by the World Health Organization (2016) indicate that there are more than 50,000 million people diagnosed with epilepsy worldwide (World Health Organization, 2016).
Its clinical course derives from the presence of an abnormal and / or pathological neuronal activity that results in recurrent seizures or convulsive seizures.
It is possible that epileptic seizures are characterized by an exaggerated increase in muscle tone, the development of strong muscular jerks, loss of consciousness or episodes of absences.
The sequelae of this type of pathological events will depend fundamentally on the complexity and the associated cerebral areas.
(Fernández Torrón, Esteve-Belloch, Palma, Riverol and Iriante, 2012). In this way, it is possible to see positive manifestations (behavioral, visual, olfactory, gustatory or auditory) and negative changes (aphasic, sensory or motor deficits). ) And in Todd's syndrome.
This syndrome was first described by Todd in 1854 (Urrestarazu, Iriarte, Alegre, Lázaro, Schlumberger, Artieda and Viteri, 2002).
Researcher Robert Bentley Todd, a native of Dublin, settled in London, where he achieved numerous successes in medicine and education (Pozo Alonso, Pozo Lauzán, Cordero López and Hernández Meilán, 2005).
Initially, it characterized this syndrome as a type of motor alteration that appeared after certain types of epileptic seizures, especially those that presented a motor or generalized course (Urrestarazu, Iriarte, Alegre, Lázaro, Schlumberger, Artieda and Viteri, 2002).
Thus, in the early stages, Todd's syndrome was called epileptic paralysis or post-paralytic paralysis (Sánchez Flores and Sosa Barragán, 2011).
The term Ictal period Is used in the medical and experimental fields to refer to an abnormal state that presents between the end of a seizure and the beginning of basal or initial recovery (Degirmenci and Kececi, 2016).
It is at this stage that the clinical features of Todd's syndrome or paralysis are found.
Is it a frequent pathology?
Todd's palsy is considered a rare neurological disorder in the general population and especially in adults (Sánchez Flores and Sosa Barragán, 2011).
International clinical reports indicate a higher prevalence associated with the pediatric population with epilepsy (Sánchez Flores and Sosa Barragán, 2011).
Several clinical studies, as referenced by the authors Degirmenci and Kececi (2016) indicate that Todd's palsy presents a prevalence of approximately 0.64% of patients with epilepsy examined.
What are the characteristic signs and symptoms?
The clinical course of Todd's syndrome is fundamentally related to the appearance of various motor deficits, Paresis and paralysis .
The term Paresis It is often used to refer to a partial or complete deficit of voluntary movements. Generally, it is not usually complete and associated eficeiuten functioning of the limbs.
The paresis usually has a unilateral presentation, that is, it affects one of the body halves and is associated with the motor areas affected by the epileptogenic discharge (Urrestarazu, Iriarte, Alegre, Lázaro, Schlumberger, Artieda and Viteri, 2002).
Being the most frequent, it is also possible to appear as (Sánchez Flores and Sosa Barragán, 2011):
- Monoparesia : Partial absence of movement tends to affect a single limb, upper or lower.
- Facial paresis : Partial absence of movement tends to preferentially affect craniofacial areas.
For its part, the 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 have a great clinical relevance due to both the functional limitation and the consequent preoccupation (Urrestarazu, Iriarte, Alegre, Lázaro, Schlumberger, Artieda and Viteri, 2002).
Other signs and symptoms
In some adult patients, the Todd phenomenon has to take a clinical form associated with focal neurological deficits (Sánchez Flores and Sosa Barragán, 2011):
- Aphasia : Secondary to muscular paralysis and / or involvement of the neurological areas responsible for language control, it is possible that the affected person presents a difficulty or inability to articulate, express or understand the language.
- Visual loss : A significant loss of visual acuity associated with involvement of the sensory cortical regions or various problems associated with the position of the eyes and ocular paralysis can be identified.
- Somatosensory deficit: Some alterations may appear associated with the perception of tactile stimuli, painful or the position of the body.
What is the Todd Syndrome Clinical Course?
The classic presentation of Todd syndrome is located after the condition of a generalized tonic-clonic seizure (Sánchez Flores and Sosa Barragán, 2011).
Tonic-clonic seizures are defined by a beginning associated with the development of an exaggerated and generalized muscular rigidity (tonic crisis) (Andalusian Association of Epilepsy, 2016).
Subsequently, it results in the presence of multiple uncontrollable and involuntary muscular movements (Clonic crisis) (Andalusian Association of Epilepsy, 2016).
Following this type of convulsive crisis, the onset of Todd's syndrome can be identified by the development of significant muscle weakness in the legs, arms or hands (Sánchez Flores and Sosa Barragán, 2011).
The muscular alteration can vary, taking in some mild cases the form of paresis and in other more serious the complete paralysis (Sánchez Flores and Sosa Barragán, 2011).
The duration of the Todd phenomenon is short. The symptom presentation is unlikely to exceed 36 hours (Degirmenci and Kececi, 2016).
The most common is that this type of paralysis has an average duration of 15 hours (Degirmenci and Kececi, 2016).
The persistence of these symptoms is usually associated with structural lesions caused by strokes (Degirmenci and Kececi, 2016).
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 processes of recovery (Degirmenci and Kececi, 2016).
What are the causes?
As we have noted, most of the identified cases of Todd's paralysis are associated with seizures due to primary epilepsy (Sánchez Flores and Sosa Barragán, 2011).
However, there are also other types of pathological processes and events that may lead to the presentation of seizures of a clonic tonic nature:
- Infectious processes.
- Cranioencephalic injuries .
- Stroke .
- Genetic alterations.
- Congenital cerebral malformations.
- Brain tumors
- Neurodegenerative diseases
- Inflammatory processes at the cerebral level.
How is the diagnosis made?
Physical examination, analysis of medical history and the study of primary seizures are essential in the diagnosis of Todd's syndrome.
Additionally, the following clinical criteria are usually accepted for confirmation of diagnosis: Sánchez Flores and Sosa Barragán (2011):
- Antecedents or immediate presence of seizures. They are especially associated with generalized clonic tonic 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 structural level examined through imaging tests.
- Electroencephalogram normal.
In these cases, it is essential to identify the etiological cause of seizures as they can be a direct indicator of a serious pathological process that endangers the survival of the affected person.
Is there treatment?
There is no treatment that is specifically designed for Todd syndrome.
The most frequent is that the medical intervention focuses on the treatment of the etiological cause and the control of the seizures. The first line treatment in cases of severe seizures are anticonvulsive or antiepileptic drugs.
In addition, it is beneficial to include the affected person in a physical rehabilitation program for the improvement of the alterations associated with muscular paralysis and the achievement of an optimal functional level.
- Degirmenci, Y., & Kececi, H. (2016). Prolonged Todd Paralysis: A Rare Case of Postictal Motor Phenomenon. Imedpub Journals .
- Epilepsy Foundation. (2016). Todd's Paralysis . Obtained from Epilepsy Foundation.
- 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 .
- NIH. (2011). Todd's Paralysis. National Institute of Neurological Disorders and Stroke.
- WHO. (2016). Epilepsy . Obtained from World Health Organization.
- Pozo Alonso, A. (2005). Focal epilepsy in the Nile and Todd's paralysis: experience of 11 cases. Rev Cubana Pediatr .
- Sánchez Flores, H. (2011). Todd's palsy. Archive of Emergency Medicine Mexico .
- Urrestarazu, E. (2002). Post-critical paresis during video-EEG monitoring studies. Rev Neurol .