Todd's paralysis is a temporary weakness or paralysis that can occur after a seizure. It is most commonly seen in the limbs but can also affect the face. The paralysis is usually short-lived, resolving within hours on average, but can occasionally last for days. It is caused by reduced blood flow in the brain following a seizure, which can be triggered by increases in certain chemicals that cause vasoconstriction. Todd's paralysis is diagnosed clinically based on the onset of weakness after a seizure. It should be considered as a potential cause if CT scans show abnormal perfusion patterns not explained by vascular disease.

1. Ade Wijaya, MD – May 2021
Todd's Paralysis

2. Outline:
 History
 Epidemiology
 Clinical Manifestation
 Pathophysiology
 Diagnosis
 Summary

3. History
1827,
Bravais
Hemiplegic
Epilepsy
1849, Todd
Todd’s
Paralysis
Binder DK. A history of Todd and his paralysis. Neurosurgery. 2004;54(2):480–86. discussion 486–87.
Todd RB, Schlesinger EB. Clinical lectures on paralysis, disease of the brain, and other affections of the nervous system. Philadelphia:
Lindsay & Blakiston; 1855.

4. Epidemiology
 Todd’s paralysis is commonly observed after
partial seizures or generalized tonic-clonic
seizures (GTCS)
 Incidence: 0.6-13.4 % (greater in structural
damage)
 Risk factors: Convulsive status epilepticus (CSE),
prolonged seizures, and high scores on the
Glasgow Coma Scale (GCS)
Werhahn KJ. Weakness and focal sensory deficits in the postictal state. Epilepsy Behav. 2010;19(2):138–39.
Kellinghaus C, Kotagal P. Lateralizing value of Todd’s palsy in patients with epilepsy. Neurology. 2004;62(2):289–91.
Rolak LA, Rutecki P, Ashizawa T, Harati Y. Clinical features of Todd’s post-epileptic paralysis. J Neurol Neurosurg
Psychiatry. 1992;55(1):63–64

5. Clinical Manifestation
 Upper and lower limbs in 50% of cases
 Face and the upper and lower limbs in 21.4% of
cases
 Only the upper limbs (14.2%)
 Only the lower limbs (7.1%)
 Face and upper limbs (7.1%)
 Duration: 0.5–36 hours, with an average of 15
hours
Rolak LA, Rutecki P, Ashizawa T, Harati Y. Clinical features of Todd’s post-epileptic paralysis. J Neurol Neurosurg
Psychiatry. 1992;55(1):63–64.

6. Pathophysiology
 Blood flow reduction
- Seizure  ↑ prostaglandin  vasoconstriction 
elevated free calcium concentrations in vascular
smooth muscle
 Sharp increase in metabolic activity and
peripheral neuronal failure
 Increased inhibitory activity in brain regions
regulating movement.
Xu, S. Y., Li, Z. X., Wu, X. W., Li, L., & Li, C. X. (2020). Frequency and Pathophysiology of Post-Seizure Todd's
Paralysis. Medical science monitor : international medical journal of experimental and clinical research, 26, e920751.
https://doi.org/10.12659/MSM.920751

7. Diagnosis
 Clinical diagnosis
 When CT perfusion abnormalities occur in
atypical vascular distributions, and the CT
angiography shows no corresponding large-
vessel occlusions, Todd’s paralysis should be
considered prior to acute stroke
Gelfand JM, Wintermark M, Josephson SA. Cerebral perfusion-CT patterns following seizure. Eur J Neurol. 2010;17(4):594–601.

8. Summary
 Commonly observed after partial seizures or
GTCS.
 The incidence is greater if the epilepsy is
associated with old age or stroke history.
 The duration can range from minutes to days,
depending on the type of seizure or whether the
patient has experienced cortical structural
damage.
 The etiology is associated with cerebral perfusion
abnormality after seizures.

9. THANK YOU