Todd's palsy

Epilepsy or "falling sickness" as it was called by the people in the recent past. Quite often, after the first convulsions of a person suffering from epileptic seizures, convulsions begin to "twist" them, which received the medical term Todd's paralysis. Signs of paralysis or paresis, which begin to appear after a seizure, were first described in 1855 by the English physician Robert Benkley Todd (RB Todd), after which this medical phenomenon received its name.

Causes Todd's palsy.

Despite the high level of medical research, to date it has not been possible to establish the causes of Todd's paralysis. Therefore, it is impossible to talk about the possibility of influencing this process.

Medical specialists, based on indirect data, can only assume that the source of the development of the pathological symptoms in question may be the phenomenon of inhibition, the provocateur of which is the dysfunction of neurotransmitter systems.

Other causes of pathology are presumably:

• Status epilepticus, in which the seizure occurs one after another, usually within half an hour.
• Brain exhaustion.
• A tumor that affects brain tissue.
• Encephalitis, especially of a herpetic nature.
• Focal postviral encephalitis.
• Lipid metabolism disorders.
• Increased triglyceride levels combined with decreased HDL (high-density lipoprotein) cholesterol levels.
• History of ischemic cerebrovascular disease.
• Presence of coronary heart disease.

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Symptoms Todd's palsy.

An epileptic seizure begins – a picture not for the faint of heart. But the consequences of the convulsions also do not bring relief to the patient. Symptoms of Todd's paralysis can manifest themselves in the inability of the victim in the post-epileptic period to perform any movements.

A person can remain in this state for one to two days. Most often, doctors record one-sided paralysis (complete absence of voluntary movements) or paresis (decreased strength in a muscle or group of muscles). Gradually, the motor blockade regresses.

There are known cases of disturbances in the functioning of the visual and speech apparatus.

Initially, when such symptoms appear, this picture can be assessed as a stroke. In the early stages of its manifestation, only an experienced specialist can differentiate the diagnosis. But over time, after one or two days, the motor function of muscle tissues begins to gradually recover, while with a stroke this does not happen so quickly.

Todd's post-epileptic paralysis

Postictal movement disorder, which can be observed for several minutes, hours, sometimes up to several days after the onset of epilepsy, is referred to by doctors as post-epileptic Todd's paralysis.

In this case, specialists can state a complete loss of the ability to make voluntary movements in one half of the body, as a result of a disruption in the conductivity of the central neuron (hemiplegia) or paralysis limited to one of the limbs (monoplegia). Local damage to brain tissue is observed.

Diagnostics Todd's palsy.

Doctors have at their disposal a fairly wide range of tools and methods developed to help in making a particular diagnosis. Diagnosis of Todd's paralysis consists primarily in classifying the severity of the damage received by the patient. Using a special test, the attending physician determines the level of muscle immobilization, their weakness, conducting a physical examination.

The division is based on a five-point system:

• Five points – complete absence of paralysis, the patient’s muscle strength is normal.
• Four points – strength indicators are reduced, but the victim has not lost activity, he is able to overcome the resistance of the doctor’s hand almost normally.
• Three points – symptoms of stiffness of movement are visually observed, but the victim is able to make certain movements, overcoming gravitational forces, but it is already problematic for him to overcome the resistance of the doctor’s hand.
• Two points – the movements are very weak, the person is not able to overcome the Earth’s gravitational forces.
• One point – minimal signs of motor activity are observed.
• Zero points – there is no movement activity at all, complete paralysis.

After this, the doctor collects a very thorough medical history of the patient.

Further diagnostics of Todd's paralysis is carried out on the basis of the following diagnostic methods:

1. Computer tomography of the brain. Allows to recognize a recent hemorrhage or determine the location of a stroke affecting a large area of brain tissue.
2. Diffusion-weighted magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA) has significant advantages over computed tomography, especially in the early differentiation of cerebral ischemia and obtaining research results on the state of the cerebral vessels.
3. Cerebral angiography is a method of visualizing the blood vessels of the brain by injecting a contrast agent into them and then taking X-rays. This study is prescribed when magnetic resonance imaging does not allow a diagnosis to be made.
4. Electrocardiography (ECG) is a method of electrophysiological study of the heart's activity in normal and pathological conditions, recording the total electrical activity of the heart from certain areas of the body.
5. Echocardiography (EchoCG) is a diagnostic ultrasound examination technique that allows visualization of functional and morphological disorders in cardiac tissues and heart valves. It is based on receiving a reflected signal from the structural components of the heart.
6. An electroencephalogram (EEG) is a test that measures and records the level of electrical activity in the brain.

Only after carrying out all the necessary research activities can the attending physician make a correct diagnosis.

Treatment Todd's palsy.

The diagnosis has been established, and measures can be taken to stop the problem. Due to the fact that there are no clear reasons that provoke the development of the pathology in question in the post-epileptic period, it is impossible to talk about highly effective therapy. Medical personnel carry out symptomatic treatment of Todd's paralysis, since the signs of pathological immobilization of the body or a separate group of muscles are immediately visible and begin to regress on their own in a fairly short period of time.

If the level of paralysis is weak, then the use of any medications is not required. In more severe pathologies, the attending physician often prescribes drugs from the benzodiazepine group to his patient. This may be midazolam (Midazolamum), diazepam (Valium), lorazepam (Ativan), as well as fosphenytoin (Cervex) or phenytoin (Dilantin).

Lorazepam (Ativan) is prescribed orally at 1 g two to three times a day. In the absence of a therapeutic effect, the dosage can be increased to 4 to 6 g daily, but not higher.

Contraindications for this drug include: increased intolerance by the patient's body to one or more components of lorazepam, as well as if the patient has a history of closed-angle glaucoma, drug and/or alcohol addiction, liver and/or kidney dysfunction, and others.

Of the second-line pharmacological drugs, phenytoin is used intravenously, diluted with 0.9% saline. The amount of the drug administered is calculated as 10-15 mg per kilogram of the patient's weight. The drug is administered slowly, no faster than 50 mg/min.

Prevention

There are currently no effective, unambiguous recommendations for preventing the pathology in question. Therefore, doctors can recommend only one prevention of Todd's paralysis: lead a healthy lifestyle and take care of your health by regularly undergoing preventive examinations in specialized institutions.

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Forecast

If the paralytic symptoms are weakly manifested, then there is no need to apply any significant treatment. The prognosis of Todd's paralysis in such a situation is favorable, all body functions return to normal and are restored fairly quickly.

If the paralysis is complete and long-term, the situation is somewhat more complicated, but one way or another, the sensitivity and strength of muscle tissues are still restored, albeit more slowly; it is more complicated with epilepsy itself, an attack of which can happen at any moment.

How much a person still does not know about himself, his body and those diseases that threaten his health. Not long ago, one of them was described - Todd's paralysis, which, without causing much and long-term discomfort, is still a serious signal from the body about its defeat. Regrettably, the roots of the disease discussed in this article have not yet been fully identified, and the hypotheses put forward by modern doctors have not yet been fully studied.

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