Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A normally healthy 6-year-old woke in an agitated state, limp, and moving only her left extremities. Upon arrival at the emergency department, a blood glucose measurement was 34 mg/dL. The child was lethargic, not responding to questions appropriately, and not moving her right extremities. The right arm was flexed, and the right leg was flexed and abducted. Pupils were equal and reactive, and eyes were deviated to the left. Six loose tablets of the grandmother's glyburide were found at home in the child's outdoor playhouse. Administration of glucose produced no change in the child's clinical condition. Intravenous glucose was begun at 4 mg glucose/kg/min, and the blood glucose level did not fall below 74 mg/dL after that. Over the next 48 h, the hemiparesis and mental status changes resolved without sequelae. The events of the case suggest a hypoglycemia-induced seizure with subsequent Todd's paralysis. Early direct medical evaluation in suspected glyburide ingestions in children is suggested.
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PMID:Hemiparesis and altered mental status in a child after glyburide ingestion. 961 Sep 73

We describe a case with symptoms of transient diffuse right hemisphere dysfunction (hemispatial neglect, dyscalculia, and disturbance of both spatial construction and visuospatial perception) occurring after status epilepticus. The clinical picture of this case suggested to us that these features could be understood as a variant of Todd's paralysis.
Seizure 2001 Mar
PMID:Cognitive dysfunction of right hemisphere-like Todd's paralysis after status epilepticus: a case report. 1140 56

This study investigated the clinical and EEG characteristics of initial status epilepticus (SE) during infancy in patients with mesial temporal lobe epilepsy (MTLE). The subjects were six patients who had been brought to our emergency clinic and treated for their initial SE between 1977 and 1988, and later developed MTLE. We reviewed the medical records and laboratory findings at the time of the initial SE, and the clinical evolution up to the development of MTLE. The six patients included four females and two males. The initial SE developed at ages ranging from 7 months to 2 years and 9 months with a mean of 1 year and 2 months. These episodes were characterized by an elevated temperature of more than 38 degrees C (4/6 cases), clusters of prolonged seizures during one episode of SE (4/6 cases), long-lasting SE (120-380 min, mean 227 min, 6/6 cases), postictal prolonged loss of consciousness (median 5 h, 6/6 cases), and the presence of Todd's paralysis (3/6 cases). The lateralization of the ictal or postictal EEGs of the SE in five of the six cases was identical to that of the hippocampal atrophy later confirmed by MRI. Follow-up EEG examinations at a 6 month interval demonstrated temporal spike discharges appearing only after the onset of complex partial seizures. Two patients, who had no fever at the initial SE, were characterized by a very early appearance of epileptic EEG abnormality and a short interval between the initial SE and the development of complex partial seizures, suggesting that the SE was the first epileptic manifestation. The result of this study showed that SE progressing to MTLE tends to have complicated clinical manifestations characterized by clusters of unilateral or generalized SE followed by prolonged postictal unconsciousness, generalized clinical manifestations despite lateralized ictal EEG discharges, and the Todd's paresis in addition to the prolonged seizure duration.
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PMID:Clinical and EEG analysis of initial status epilepticus during infancy in patients with mesial temporal lobe epilepsy. 1201 66

Postictal psychosis is a rare complication of epileptic seizure characterized by reversible psychotic symptoms after flurries of seizure attack. It has been attributed to a phenomenon similar to Todd's paralysis without definitive proof. We studied regional cerebral blood flow (rCBF) of six patients with postictal psychosis by (99m)Tc-HMPAO SPECT scan. Baseline rCBF was compared with the rCBF during postictal psychosis. An asymmetry index (ASI) was calculated as 200 x [(ipsilateral ROI count density - contralateral ROI count density)/(ipsilateral ROI count density + contralateral ROI count density)] %. Significant differences could be found between ASIs during postictal psychosis and interictal state SPECT scan over the lateral temporal neocortex region (P = 0.017). Although hyperperfusion abnormality in SPECT can be found in Todd's paralysis, such findings are more commonly found in cerebral hyperactivity conditions. Taking into account the clinical characteristics of postictal psychosis, namely a preceding lucid interval and crescendo-decrescendo clinical course, these may be an alternative psychopathogenic mechanism for the development of postictal psychosis.
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PMID:Lateral temporal hyperperfusion in postictal psychosis assessed by 99mTc-HMPAO SPECT. 1241 1

Management of a first seizure is a frequent challenge in the emergency room. Definite diagnosis is mandatory before treatment, identification of the epileptic syndrome is recommended. The overall recurrence rate of a first unprovoked seizure is about 50%, but varies considerably depending on several risk factors (neurological deficit in particular, a congenital one, Todd's paralysis, significant psychiatric disorders, epilepsy in siblings, symptomatic seizures (MRI is the standard procedure now to detect a structural lesion, except in case of a idiopathic generalised epilepsy and epilepsy with centro-temporal spikes) and epileptiform abnormalities on EEG which should be obtained within 24 hours after a seizure. Each treatment decision has to be taken individually after discussion with the patient. Early treatment reduces the 2 years recurrence rate but doesn't alter the long term prognosis.
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PMID:[Management of a first epileptic seizure in adults]. 1585 19

Current treatment protocols using reperfusion therapy for acute ischemic stroke rely on non-contrast computed tomography (NCCT), with most indications including the absence of acute hemorrhage or large volume of infarction in the presence of clinical signs and symptoms. This predictably results in a significant incidence of the administration of reperfusion therapy to patients with "stroke mimics," such as migraine headache or Todd's paralysis after a seizure. Diffusion-weighted imaging (DWI) is a technique based on magnetic resonance imaging (MRI) that may be more sensitive and specific for acute cerebral ischemia than NCCT. In addition, data for techniques such as perfusion-weighted imaging can be acquired with minimal additional time required. This may allow better risk assessment of a clinical response to reperfusion therapy vs. the possibility of hemorrhagic complications. This article describes a methodical review of studies comparing the sensitivity, specificity, positive predictive value, and negative predictive value of DWI vs. NCCT in the evaluation of acute ischemic stroke. Data from studies meeting our screening criteria are combined to produce overall values for each.
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PMID:Diffusion-weighted magnetic resonance imaging versus computed tomography in the diagnosis of acute ischemic stroke. 1698 60

Familial cerebral cavernous malformations (CCMs) occur with a frequency of 1 in 2000 and may cause recurrent headaches, seizures, and hemorrhagic stroke. Exon-scanning-based methods have identified intragenic mutations in three genes, CCM1, CCM2, and CCM3, in about 70% of familial CCM. To date, only two large CCM2 and a single large CCM3 deletion have been published. In addition to direct sequencing of all three CCM genes, we applied a newly developed multiplex ligation-dependent probe amplification gene dosage assay (MLPA) designed to detect genomic CCM1-3 deletions/duplications. Direct sequencing did not reveal a mutation in the index case who presented with multiple CCMs that had caused a generalized tonic-clonic seizure with Todd's paralysis and headaches at the age of 5. In contrast, MLPA analyses detected a large deletion involving the entire CCM1 coding region in the proband and further affected members of this German CCM family. The MLPA results were corroborated by analyses of single nucleotide polymorphisms (SNPs) within the CCM1 gene. Thus, we here present the first report on a CCM1 gene deletion. Our results confirm a loss-of-function mutation mechanism for CCM1 and demonstrate that the use of MLPA enables a higher CCM mutation detection rate which is crucial for predictive testing of at-risk relatives.
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PMID:CCM1 gene deletion identified by MLPA in cerebral cavernous malformation. 1718 87

The aim of this study was to assess recurrence risk after a first remote symptomatic unprovoked seizure in childhood. All consecutive patients younger than 14 years with a first remote symptomatic unprovoked seizure who were seen at our hospital between 1994 and 2006 were included in the study and prospectively followed. Only two patients received antiepileptic treatment. Sixty-three children were included, with 35 males and 28 females. Mean age at first seizure was 4 years (SD 3y 5mo). Kaplan-Meier estimate of recurrence risk was 59% (95% confidence interval [CI] 47-71), 76% (95% CI 65-87), 85% (95% CI 76-94), and 87% (95% CI 78-96) at 6, 12, 18, and 24 months respectively. A total of 55 children out of 63 were affected by a static encephalopathy of pre- or perinatal origin. In this subgroup, recurrence risk at 12 and 24 months was 79% (95% CI 68-90) and 89% (95% CI 80-98). Univariable analysis using the Cox proportional hazards model showed that presence of global developmental delay/intellectual disability and Todd's paresis were associated with a significant increase in recurrence risk. In multivariable analysis, only Todd's paresis was significantly associated. Recurrence risk after a first remote symptomatic unprovoked seizure in childhood is much higher than what some previous studies suggests.
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PMID:Recurrence risk after a first remote symptomatic unprovoked seizure in childhood: a prospective study. 1902 79

The clinical differentiation between stroke and seizure is usually straightforward but postictal neurological deficits can be mistaken for stroke in case no detailed medical history is available. Up to now, the imaging findings of Todd's paresis are not well described. This case report demonstrates that postictal paresis can be accompanied by a reversible global hemispheric hypoperfusion as measured with perfusion MRI indicating transient but profound cerebrovascular dysfunction in postictal paresis. Extensive postictal perfusion changes must be discriminated from emerging stroke to avoid potentially harmful therapy like thrombolysis. Further investigations are warranted to clarify the role of cerebrovascular dysfunction in the pathophysiology of postictal paresis.
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PMID:Hemispheric hypoperfusion in postictal paresis mimics early brain ischemia. 2023 2

There is relatively little information on the underlying parameters that affect clinical features of the postictal period. Age-related physiological changes, including alterations in cerebral blood flow and metabolism, neurotransmitter function, and responses of the brain to seizure activity may affect postictal clinical phenomena. Some conclusions can be drawn. Elderly adults and children, particularly in the presence of diffuse cerebral dysfunction, may have more prolonged postictal confusion. Postictal dysphasia strongly suggests a dominant hemisphere focus, more often temporal, and Todd's paralysis is always contralateral to the epileptogenic zone. Much additional information could be derived from the vast amount of video/EEG monitoring data available.
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PMID:The postictal state: effects of age and underlying brain dysfunction. 2072 20


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