{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T11:34:08Z","timestamp":1790508848300,"version":"4.1.0"},"reference-count":8,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T00:00:00Z","timestamp":1725926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Postictal paresis (\u201cTodd's paralysis\u201d) is commonly observed as a unilateral, transient motor weakness, lasting minutes to hours, after focal or focal to bilateral tonic\u2013clonic seizures, contralateral to the epileptogenic zone. Bilateral postictal paresis is exceedingly rare and could be misinterpreted, especially if the preceding convulsive phase was not witnessed. An 18\u2010year\u2010old right\u2010handed male patient with refractory focal epilepsy with seizure onset at age 3\u2009years, was admitted for presurgical video\u2010EEG monitoring. His seizures were predominantly nocturnal, consisting of a laryngeal somatosensory aura, occasionally evolving to bilateral tonic or tonic\u2013clonic seizures with occasional asymmetrical limb extension during the tonic phase (right arm extension). Postictally, consciousness recovery was fast, if ever lost. At that stage, we documented severe dysarthria and bilateral symmetrical arm paresis lasting several minutes. The ictal pattern and interictal epileptiform activity were projected on the fronto\u2010central midline. Brain MRI was highly suggestive of a bottom\u2010of\u2010sulcus dysplasia with underlying transmantle sign on the left premotor, fronto\u2010opercular region and an FDG\u2010PET\u2010CT showed a concordant left fronto\u2010operculo\u2010insular hypometabolism. A complete lesionectomy was performed, with the additional guidance of intraoperative electrocorticography, resulting in sustained seizure freedom. Anatomo\u2010pathology confirmed a type 2b focal cortical dysplasia. We speculate that, in our patient, a left fronto\u2010opercular ictal onset with an early spread to both primary motor cortices and relative sparing of consciousness networks allowed the emergence of a clinically detectable postictal bilateral paresis.<\/jats:p>","DOI":"10.1002\/epd2.20278","type":"journal-article","created":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T13:46:53Z","timestamp":1725976013000},"page":"853-857","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Bilateral Todd's paralysis in a patient with left fronto\u2010opercular epilepsy"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0537-1340","authenticated-orcid":false,"given":"Daniela Santos","family":"Oliveira","sequence":"first","affiliation":[{"name":"Neurology Department Unidade Local de Sa\u00fade Entre Douro e Vouga  Santa Maria da Feira Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Rocha","sequence":"additional","affiliation":[{"name":"Neurophysiology Unit, Neurology Department Unidade Local de Sa\u00fade S\u00e3o Jo\u00e3o  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duarte","family":"Vieira","sequence":"additional","affiliation":[{"name":"Neurorradiology Department Unidade Local de Sa\u00fade S\u00e3o Jo\u00e3o  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Rito","sequence":"additional","affiliation":[{"name":"Neurosurgery Department Unidade Local de Sa\u00fade S\u00e3o Jo\u00e3o  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Rego","sequence":"additional","affiliation":[{"name":"Neurophysiology Unit, Neurology Department Unidade Local de Sa\u00fade S\u00e3o Jo\u00e3o  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,10]]},"reference":[{"key":"e_1_2_5_2_1","article-title":"Frequency and pathophysiology of post\u2010seizure Todd's paralysis","volume":"26","author":"Xu SY","year":"2020","journal-title":"Med Sci Monit"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2010.06.029"},{"key":"e_1_2_5_4_1","volume-title":"StatPearls [Internet]","author":"Mastriana J","year":"2022"},{"key":"e_1_2_5_5_1","volume-title":"Clinical lectures on paralysis, disease of the brain, and other affections of the nervous system","author":"Todd RB","year":"1855"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000103490.49537.37"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.62.12.2160"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1992.tb01766.x"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.789"}],"container-title":["Epileptic Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epd2.20278","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T16:19:58Z","timestamp":1734452398000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epd2.20278"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,10]]},"references-count":8,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1002\/epd2.20278"],"URL":"https:\/\/doi.org\/10.1002\/epd2.20278","archive":["Portico"],"relation":{},"ISSN":["1294-9361","1950-6945"],"issn-type":[{"value":"1294-9361","type":"print"},{"value":"1950-6945","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,10]]},"assertion":[{"value":"2024-06-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}