One retrospective observational study evaluated 328 selected patients from ages 16 to 57 years who had prolonged video-electroencephalogram (EEG) monitoring for medically intractable epilepsy and focal seizure onset; those with nonepileptic seizures, status epilepticus, and Lennox-Gastaut syndrome were excluded. The following observations were made:
PP occurred in 44 patients (13.4 percent)
PP was always unilateral and always contralateral to the seizure focus
The mean duration of PP was 174 seconds (range 11 seconds to 22 minutes)Of all seizures followed by PP, the following features were noted:
Obvious ictal motor activity was seen in 78 percent (Todds paresis is more common after any clonic seizure activity)
Very slight ictal motor activity was seen in 10 percent
No ictal motor activity was seen in nearly 10 percent
The most common ictal lateralizing sign was unilateral clonic activity in 56 percent
Ictal dystonic posturing occurred in 48 percent
Ictal limb immobility occurred in 25 percentThe results of this study are valuable because few other data exist on the frequency, duration, and seizure characteristics associated with PP. However, the study is likely biased by the inclusion only of patients with medically intractable seizures who had undergone video-EEG monitoring, and the results may not extrapolate to a general epilepsy population.Other post-ictal neurological findings that do not involve activity of the area affected by the seizure have been described. They are thought to be caused by a different mechanism than Todds paresis, and including paralysis of the contralateral limb, and rare genetic causes of hemiplegia and seizures.
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