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    Abstract
   Introduction
   Discussion
    References

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 Table of Contents    
CASE REPORT  
Year : 2012  |  Volume : 54  |  Issue : 2  |  Page : 192-193
A case of Todd's Palsy following unilateral electroconvulsive therapy


1 Department of Anaesthesia, Ysbyty Glan Clwyd Hospital, United Kingdom
2 Department of Psychiatry and Associate Medical Director (Betsi Cadwaladr University Health Board) and Visiting Professor (Glyndwr University, Wrexham), United Kingdom
3 Department of Psychiatry, Ysbyty Glan Clwyd Hospital, United Kingdom

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Date of Web Publication8-Aug-2012
 

   Abstract 

This case describes a woman undergoing unilateral electroconvulsive therapy (ECT) who developed a Todd's Palsy following the treatment, and which resolved when converted to bilateral ECT. We go on to hypothesize that this rare side effect may be an indication of the need to switch laterality during a course of ECT.

Keywords: Electroconvulsive therapy, Todd′s palsy, bilateral electroconvulsive therapy, unilateral electroconvulsive therapy

How to cite this article:
Bell C, Lepping P, Clifford J, Gardner-Thorpe C. A case of Todd's Palsy following unilateral electroconvulsive therapy. Indian J Psychiatry 2012;54:192-3

How to cite this URL:
Bell C, Lepping P, Clifford J, Gardner-Thorpe C. A case of Todd's Palsy following unilateral electroconvulsive therapy. Indian J Psychiatry [serial online] 2012 [cited 2018 Jan 20];54:192-3. Available from: http://www.indianjpsychiatry.org/text.asp?2012/54/2/192/99541



   Introduction Top


A 40-year-old woman was referred for electroconvulsive therapy (ECT) for a severe depressive illness. She had a background of severe psoriasis for which she received methotrexate for nearly 20 years and adalimumab by subcutaneous injection every 2 weeks. She had asthma for which she received seretide and salbutamol inhalers. She was also taking venlafaxine 225 mg mane and mirtazepine 45 mg nocte.

Prior to her commencing ECT, she was noted to have a chest infection. She had been commenced on prednisolone, amoxycillin and ipratropium and her first session was cancelled owing to her dyspnea and widespread wheeze, although she was apyrexial. It had already been agreed with the patient that she would commence unilateral ECT owing to concerns about cognitive side effects.

On the first session the patient was given a 5% stimulus from a thymatron IV machine using the D'Elia placement, producing a 39-s seizure which was taken to be the seizure threshold. No ill effects were noted at any point and the patient made a full recovery.

On the second session however the patient received a stimulus of 30% in the same position and administered by the consultant, in line with recent developments in unilateral application. [1] The patient had a 22-s generalized seizure monitored by a 2-lead encephalogram. She was then transferred to the recovery room. As she recovered, she complained of pain around her right eye and was dysarthric. On clinical examination she was noted to have an injected right conjunctiva and a right facial palsy affecting her right eye, and mouth. The forehead was spared and no limb abnormalities were found.

The patient's symptoms were however short lived and fully resolved after 20 minutes. The patient made a full recovery but ECT was suspended while she had further investigations advised by the neurologist. This included a C-reactive protein which was normal and MRI brain which revealed no abnormality.

The patient subsequently continued with bilateral ECT for 20 sessions and made a good recovery from the depressive disorder and no further neurological sequelae were observed.


   Discussion Top


Todd's Paralysis is described as a temporary weakness usually affecting one or more limbs and which usually occurs after a focal seizure. [2] However, a similar phenomenon resulting in language, somesthetic and visual deficits can occur depending on the focal area involved. [2]

The rationale for converting to bilateral ECT was to avoid a focal seizure which may have been significant in producing this focal neurology.

This condition has not been described in connection with ECT as far as we are aware. This may represent a rare indication of the need to convert from unilateral to bilateral ECT.

 
   References Top

1.Kellner CH, Knapp R, Husain MM, Rasmussen K, Sampson S, Cullum M, et al. Bifrontal, bitemporal and right unilateral electrode placement in ECT: Randomised trial. Br J Psychiatry 2010;196:226-34.  Back to cited text no. 1
[PUBMED]    
2.'Clinical Neurology' 2 nd ed Marsden and Fowler. 'Principles of Neurology' Adams and Victor 9 th Ed, New York City, U.S: McGraw Hill.  Back to cited text no. 2
    

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Correspondence Address:
Peter Lepping
Wrexham Academic Unit, Technology Park, Croesnewydd Road, Wrexham, LL13 7TY
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.99541

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