Clinical features of Todd's post-epileptic paralysis

Area of Science:

• Neurology
• Epileptology
• Clinical Neuroscience

Background:

• Generalized tonic-clonic seizures are a common form of epilepsy.
• Transient focal neurological deficits following seizures are known as Todd's post-epileptic paralysis (PEP).
• The clinical spectrum and associated factors of PEP require further elucidation.

Purpose of the Study:

• To prospectively evaluate the clinical characteristics of Todd's post-epileptic paralysis (PEP) in patients with generalized tonic-clonic seizures.
• To identify potential associations between PEP and underlying focal brain lesions.
• To describe the heterogeneity in the presentation, severity, and duration of PEP.

Main Methods:

• Prospective evaluation of 229 patients with generalized tonic-clonic seizures.
• Identification and detailed clinical assessment of patients experiencing transient focal neurological deficits (PEP).
• Correlation of PEP symptoms with the presence of underlying focal brain lesions.

Main Results:

• Fourteen patients (6.1%) exhibited Todd's post-epileptic paralysis (PEP).
• Eight of these 14 patients had associated focal brain lesions.
• PEP presented with variable weakness (pattern, severity, tone, reflexes), aphasia (5 patients), and gaze palsy (4 patients); sensory loss was rare.
• PEP duration ranged from 0.5 to 36 hours (mean 15 hours).
• PEP occurred heterogeneously, not necessarily after every seizure or early in the disease course.

Conclusions:

• Todd's post-epileptic paralysis (PEP) is a heterogeneous neurological deficit following generalized tonic-clonic seizures.
• The presence of underlying focal brain lesions is associated with PEP in a significant proportion of cases.
• Clinicians should be aware of the wide variability in PEP presentation and duration.