Todd's palsy: description, symptoms and treatment

Learn more about diseases starting with the letter “P”: Panic attacks; Duchenne-Erb's palsy; Todd's palsy; Parasomnias; Paroxysmal hemicrania; Paroxysmal myoplegia, Paroxysmal positional vertigo; Peripheral autonomic failure; Hepatic encephalopathy; Pineoblastoma; Pineocytoma; Writer's cramp; Platybasia; Plexites; Brachial plexitis; Humeroscapular periarthrosis; Pneumococcal meningitis Pneumocephalus; Subacute sclerosing panencephalitis; Spinal cord injury.

Todd's palsy is a temporary, transient condition of central weakening or paralysis in one or both limbs that appears after the end of an epileptic seizure. It is a sign of depletion of the central nervous system and can signal the presence of a tumor in the brain and a disruption of metabolic processes.

Diagnosis of post-epileptic paralysis is carried out by excluding acute disturbances in cerebral blood flow after MRI and CT scans of the brain. For additional diagnostic purposes, electroencephalography, examination of cerebral vessels, and examination of internal organs are prescribed.

Treatment is not prescribed if underlying diseases are not detected. In this case, epilepsy is treated.

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.

Symptoms in children

Todd's palsy in children has some differences from the manifestation of the same pathology in adults. This is due to the peculiarity of the fragile children's nervous system.

As a rule, epileptic seizures in childhood are more intense than in adults, which is due to the instability of the processes of inhibition and excitation of the nervous system due to incompletely formed metabolism. Therefore, Todd's paresis in childhood is expressed more clearly than in adults. However, in this case, the neurological symptoms disappear on their own after 24-48 hours.

Causes

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.

Factors causing Todd's palsy

The causes of Todd's palsy and the mechanism by which the condition develops are under study. Scientists in the field of medicine and physiology have determined the relationship between post-epileptic movement disorders and immoderately progressive inhibition processes originating in the central nervous system.

Paralysis is the result of neurotransmitter deficiency and weakening of brain functions. This statement is not without foundation, since Todd's palsy in most cases is recorded with:

organic diseases of the brain – encephalitis;
cerebrovascular accidents;
tumors of the central nervous system;
severe primary diseases - liver failure, chronic renal failure, cardiovascular failure, diabetes mellitus, tuberculosis, septic conditions.

The paralytic state is caused by dysmetabolic, ischemic and toxic effects on the central nervous system. Todd's paralysis usually occurs after an epileptic seizure that lasts more than half an hour. Laboratory studies show that lipid metabolism is disrupted in patients, triglyceride levels increase, and cholesterol saturation decreases.

Symptoms

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 paralysis

When central and peripheral neurons are damaged, different symptoms occur. Spastic paralysis is the result of damage to central motor neurons, flaccid paralysis is a consequence of damage to peripheral neurons. With psychogenic paralysis, features of either one or another type of paralysis described above appear. With central paralysis, sensory and trophic disorders appear, and vascular tone changes. As a rule, problems with motor function in general arise. Muscles that are in a paralyzed state are very tense, but they do not atrophy. In the limbs with paralysis, tendon reflexes are preserved or strengthened, and sometimes rapid spastic contractions called clonus . Abdominal reflexes are low or absent altogether. If the lower limbs are paralyzed, then a sign of brain damage is the Babinski reflex , which is characterized by dorsiflexion of the thumb after deliberate irritation of the outer edge of the sole. With peripheral paralysis, sensitivity is impaired. At the same time, muscle tone decreases, individual muscles are damaged, which atrophy and degenerate. In limbs that are paralyzed, there are no deep reflexes or they are very low, and clonus does not appear. Abdominal reflexes are present, but Babinski's reflex is absent.

Diagnostics

Five points means a complete absence of symptoms, the patient’s muscles are in a state of physiological norm.
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.
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.
Two points - the Earth's gravity becomes an insurmountable obstacle for such a patient.
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.

Todd's palsy: description, symptoms and treatment

Todd's palsy is a type of neurological disorder associated with the occurrence of areas of excitation in the brain. It can last from a few minutes to a day. To make this diagnosis, it is necessary to exclude all other similar pathologies, including organic damage to the nervous system. 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.

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 more 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.

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.

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, a physical examination is carried out and the data obtained are compared with a five-point scale: Five points is a complete absence of symptoms, the patient’s muscles are in a state of physiological norm. 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. 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. Two points – the Earth’s gravity becomes an insurmountable obstacle for such a patient. 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.

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.

Diagnostic criteria

Modern doctors are equipped with a wide range of different techniques designed to accurately diagnose almost any disease. Diagnosis begins with a test, according to which the attending physician determines the degree of muscle damage in scores.

Muscle immobilization is assessed on a five-point scale:

5 points - the patient has no paralysis, no muscle weakness is observed;
4 points - the patient has not lost motor activity, but muscle strength decreases, the person is able to resist the movements of the doctor’s hand;
3 points - the victim’s movements are constrained, but the patient can move, overcoming gravitational forces.
2 points - motor activity is weak, the patient cannot overcome the gravity of the Earth;
1 point - minimal physical activity;
0 points - the patient is completely paralyzed, there is no movement.

After studying the test results, the doctor begins to examine the patient’s medical history.

Further diagnosis is based on the following methods:

CT scan of the brain . Allows you to detect early hemorrhages and the presence of a stroke.
MRI or MRA . Study of the state of cerebral vessels.
Cerebral angiography . A method of examining brain vessels in which a contrast agent is injected into the vessels.
ECG . A method for studying the functioning of the heart in normal and pathological conditions.
EchoCG . A technique for visualizing the state of cardiac tissues and clans.
EEG . An examination to determine electrical brain activity.

After a complete examination, the attending physician is able to make an accurate diagnosis and prescribe the correct treatment for the disease.

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.

Consequences and prognosis

If the symptoms of paralysis are mild, then there is no need to take medications. This form of the disease is not a threat, but rather is beneficial. All pathological symptoms will soon disappear and the body will fully recover.

The situation is a little more complicated if the symptoms of Todd syndrome are long-lasting and full-blown. Severe manifestations of the disease can negatively affect human health.

However, muscle weakness will disappear, albeit not so quickly, but muscle strength will be fully restored and they will be able to function properly. In this case, it is more difficult for victims to predict epileptic attacks, since they can happen at any inopportune moment.