Abstracts

The etiology of Todd[apos]s paralysis is still unclear, after original description of this phnomenon more than one century ago.
We are presenting a case that supports the theory of transient excessive inhibitory discharges in an intact brain as the underlying cause. We are reporting our observation in an elderly man with history of major depression who developed predictable recurrent Todd[apos]s palsy after each unilateral electro-convulsive therapy (ECT). Exclusive right-sided ECT resulted on left hemiparesis that lasted several hours to several days. However, the duration of post ictal hemiparesis declined over time along with increasing threshold for electrical induction of generalized seizures. EEGs prior to ECTs were always normal, however, unilateral right-sided intermittent polymorphic delta activity were noted when EEGs were performed within the first twenty-four hours of ECTs. MRIs of brain were repeatedly normal. Our case demonstrates that under controlled environment with unilateral electrical stimulation of brain, post-ictal hemiparesis is predictable and replicable in a certain cases.
In addition, pre-existing focal structural cortical lesion and focal interictal epileptogenic zone are not required for the development of Todd[apos]s palsy.
To our knowledge, this is the first reported case of post-ictal hemiparesis after unilateral ECT despite application of this procedure to thousends of patients every year.