Q: What is Todd’s paralysis?
A: Todd’s paralysis is a type of temporary paralysis seen after a seizure experienced by some people with epilepsy. Todd’s paralysis commonly affects one hand, arm, or leg, but the condition can affect the whole body. The effects can range from a weakness in one part of the body to a full loss of movement and sensation. Symptoms can also include temporary problems with sight or speech.
Symptoms can last from minutes to days. No treatment is needed, with symptoms spontaneously resolving usually within 36 hours. It is not a stroke, it is the brain recovering from a seizure, and this can have a physical impact on the body.
It can also be referred to as Todd’s paresis, Todd’s palsy, or postictal paresis.
Q: I have started a new medication. How long should I wait to decide if a medication change has been effective?
A: Antiseizure medications act in different ways and affect each person individually. A change in medication is a slow process and it usually involves a slow introduction and sometimes weaning off another medication at the same time. Or it may be introducing a new medication in addition to the old one. Either way, the true effectiveness of the second medication won’t be apparent until the changeover process is complete and the medication dose at an effective level for you. Ideally this effective level shouldn’t be causing too many unwanted side effects because that would not be considered effective if you have to live with unacceptable side effects to get seizure control.
So, the time period will be different for everyone. A rough time frame would be 3-6 months, but sometimes seizure patterns wax and wane a bit, or a new medication may initially work well, then become less effective, so it is probably best to wait 6-12 months unless you are having intolerable side effects.
Just remember if you currently have seizure control and hold a drivers licence, then you will need to refrain from driving for this period. Speak to your doctor how long you will be unable to drive.
Q: What is an aura? My doctor says they are seizures.
A: Yes that’s right. An aura is actually a focal seizure where a person retains awareness and knows what is happening around them and can later describe it. They are termed focal aware seizures.
People tend to call it an aura because often it happens just before a more significant seizure, but it is actually the start of the seizure. It can serve as a warning sign for an impending seizure, but it can happen on its own as well. The way it presents is different from person to person, but symptoms can include:
- movements, such as jerking, posturing or stiffening of a limb, twitching of face
- sensations, such as numbness, tingling or burning feeling in a part of the body
- involuntary body changes, such as blushing, looking pale, increased heart rate, butterflies in the stomach, nausea, and perspiring
- unable to speak, déjà vu, hallucinations (visual, smell, taste or hearing), or perceptual distortions
- emotions such as joy, sadness, anxiety, fear, or panic.
Q: I was diagnosed with epilepsy last year at age 78. I used to be a very active person but since starting medication I have been sleepy and inactive most of the time. The doctor says I am taking an average dose range for this medication. What is the average dose range and could I be taking too much?
A: Every person is different and the dose of medication they need will depend on many factors. The ‘best dose’ is the one that controls seizures with the least amount of side effects. This differs from person to person.
For example, a recommended adult dose range for an antiseizure medication usually has a broad range as a very general guide. Most people may have their seizures controlled taking doses within this recommended range, but others may need to take a lower or higher dose. Older people often gain seizure control taking lower doses so the typical medication dose for someone in your age group tends to be at the lower end of recommended guides.
There are some things that may affect your epilepsy medication. For instance, if you are taking any other medications or have any other health conditions. This may affect how the epilepsy medication is absorbed or metabolised in the body, and the side effects of the medication. Generally, in your senior years, the medication dose should be lower than in your younger years.
An antiseizure medication is usually started at a low dose which is slowly increased until you reach the lowest dose of medication that will control seizures and not cause side effects. Sometimes experience helps your doctor know how much to give you, and when to change the dose. Other times, there’s a bit of a ‘trial and error’ approach to find out what is best for each individual.
If you have been experiencing these symptoms since starting your antiseizure medication, they may be the cause of your sleepiness. It would be worth raising your concerns with your doctor and ask for the medication to be reviewed.
