Todd's paralysis

Epilepsy or "falling" as it was called among the people even in the recent past. Quite often, after the first convulsions of epileptic seizures, a person begins to "twist" the cramps that received the medical term Todd's paralysis. The signs of paralysis or paresis, which begin to appear after a seizure, were first described in 1855 by an English physician, Robert Benclay Todd (RB Todd), after which this medical phenomenon was given its name.

Causes of the todd's paralysis

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 not necessary to talk about the possibility to influence this process.

Medical specialists, based on indirect data, can only assume that the phenomenon of inhibition, the provocation of which is the dysfunction of neurotransmitter systems, can become a source of development of the pathological symptomatology in question.

Other causes of the pathology, presumably, are:

• Epileptic status, in which this attack happens one after another, usually for half an hour.
• Cerebral depletion.
• Tumor growth, affecting the brain tissue.
• Encephalitis, especially herpetic character.
• Focal porcine encephalitis.
• Disorders of lipid metabolism.
• The increase in the level of triglycerides in combination with the lowered parameters of HDL cholesterol (high-density lipoproteins).
• Presence of an anamnesis of ischemic cerebrovascular diseases.
• Presence of ischemic heart disease.

[1], [2], [3]

Symptoms of the todd's paralysis

Epileptic seizure begins - the picture is not for the faint-hearted. But the consequences of seizures also do not bring relief to the patient. Symptoms of Todd's paralysis can manifest itself in the impossibility of the affected person in the post-epileptic period, perform any movements.

In this state a person is able to stay from one to two days. Most often, physicians fix a one-sided paralysis (complete absence of arbitrary movements) or paresis (reduction of strength in the muscle or in the muscle group). Gradually there is a regression of the motor blockade.

There are cases of violations in the work of the visual and speech apparatus.

Primarily, with the appearance of such a symptomatology, this picture can be regarded 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 the muscular tissues begins to gradually recover, when, as with a stroke, this does not happen so soon.

Post-epileptic paralysis of Todd

Postictal impairment of motor activity, which can be observed from several minutes, hours, sometimes up to several days after the epilepsy that has occurred, is labeled as post-epileptic Todd's paralysis.

In this case, specialists can state the complete loss of the possibility of voluntary movements in one half of the body, as a result of impaired conductivity of the central neuron (hemiplegia) or paralysis, limited to one of the extremities (monoplegia). Local lesions of brain tissues are observed.

Diagnostics of the todd's paralysis

At the service of physicians is a wide range of tools of various techniques developed to help with the formulation of a particular diagnosis. Diagnosis of Todd's paralysis is primarily in the classification of the severity of the diseased lesion. With the help of a special test, the attending physician determines the level of muscle immobility, their weakness, conducting a physical examination.

The division follows a five-point system:

• Five points - complete absence of paralysis, the patient's muscle strength is normal.
• Four points - the power indicators are reduced, but the victim is not lost activity, he is almost able to overcome the resistance of the doctor's hand.
• Three points - the symptoms of stiffness of motion are visually observed, but the victim is able to perform certain movements, overcoming gravitational forces, but it is already problematic to overcome the resistance of the doctor's hand.
• Two points - the movement is very weak, a person can not overcome the forces of gravity of the Earth.
• One point - there are minimal signs of motor activity.
• Zero points - activity in motion is absent completely, complete paralysis.

After that, the doctor collects the most thorough anamnesis of the patient.

Further diagnosis of Todd's paralysis is carried out on the basis of such diagnostic techniques:

1. Computer tomography of the brain. It makes it possible to recognize a recent hemorrhage, or to determine the localization of a stroke that affects a large area of brain tissue.
2. Diffuse-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 the results of studies on the state of cerebral vessels.
3. Cerebral angiography is a method of visualizing the vessels of the brain with the help of the introduction of a contrast medium into them and subsequent X-ray photography. This study is assigned in the case when the magnetic resonance study does not allow you to establish a diagnosis.
4. Electrocardiography (ECG) is a method of electrophysiological examination of the activity of the heart 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 technique for ultrasound examination that allows visualizing functional and morphological disorders in cardiac tissues and heart valves. It is based on obtaining a reflected signal from the structural components of the heart.
6. The electroencephalogram (EEG) is a survey, during which the level of electrical brain activity is measured and recorded.

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

Treatment of the todd's paralysis

The diagnosis is established, and you can take measures to stop the problem. Due to the fact that there are no unambiguous reasons provoking the development of the pathology in the post-epileptic period, it is not necessary to talk about highly effective therapy. The medical personnel undergo symptomatic treatment of Todd's paralysis, since signs of pathological immobilization of the body or a separate group of muscles can be seen immediately and begin to regress independently in a short period of time.

If the level of paralysis is poorly expressed, then the use of any medicines is not required. With a more severe pathology, often enough, the attending physician prescribes to his patient preparations from the benzodiazepine group. This may be midazolam (Midazolamum), diazepam (Valium), lorazepam (Ativan), as well as phosphenytoin (Segeuh) or phenytoin (Dilantin).

Laurazepam (Ativan) is administered orally 1 g two to three times throughout the day. In the absence of therapeutic effect, the dosage can be increased to 4-6 g daily, but not higher.

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

From the second row of pharmacological preparations, phenytoin is administered 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 medication is administered slowly, not faster than 50 mg / min.

Prevention

There are no effective unambiguous recommendations regarding prevention for the present pathology. Therefore, the prevention of Todd's paralysis by medics can be recommended only one: to lead a healthy lifestyle and to protect one's health by regularly undergoing preventive examinations in specialized institutions.

[4], [5], [6], [7]

Forecast

If the paralytic symptoms are poorly manifested, then there is no need to apply any significant treatment. The prognosis of Todd's paralysis in such a situation is favorable, all the body's functions soon enough recover and recover.

If the paralysis is complete and lasting - the situation is somewhat more complicated, but somehow the sensitivity and strength of the muscle tissues all the same, albeit more slowly, but is restored, more difficult with the epilepsy itself, the attack of which can happen at any time.

How much more a person does not know about himself, his body and those diseases that threaten his health. Not so long ago, one of them was described - Todd's paralysis, which, without bringing much and long discomfort, is still a serious signal of the body about his defeat. As it is not regrettable, the roots of the disease considered in this article have not been fully revealed to the present, and those hypotheses put forward by modern doctors have not been completely studied yet.

[8]