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Focal motor seizure with Todd's paresis — SCE Neurology MCQ

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HardEpilepsyFocal motor seizure with Todd's paresisSCE Neurology

A focal clonic seizure is followed by complete right-arm weakness that resolves over 40 minutes. CT excludes haemorrhage and EEG later shows left frontal epileptiform discharges. What is the best interpretation and next step?

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Correct answer: C — Todd paresis after a focal motor seizure; complete urgent stroke assessment

The best answer is “Todd paresis after a focal motor seizure; complete urgent stroke assessment”. Transient postictal focal weakness supports Todd paresis, but acute stroke must initially be excluded because seizure can occur at stroke onset. “A completed stroke that proves the seizure was irrelevant” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Functional weakness because imaging is normal” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Myasthenic crisis requiring IVIg” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Radiculopathy requiring urgent spinal surgery” is a credible alternative elsewhere, but it fails the decisive discriminator in this case.

Reference: NICE NG217 epilepsy recommendations: https://www.nice.org.uk/guidance/ng217/chapter/Recommendations