Painful Todd’s: Post-ictal painful hemiparesis as an identifier of insular epilepsy
The insula can generate seizures which mimic frontal, temporal and parietal epilepsies making electroclinical localization difficult. We report the case of a twenty-one-year-old woman who presented with seizure semiology of a left-sided painful somatosensory aura, progressing to bilateral tonic post...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-03-01
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| Series: | Epilepsy & Behavior Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589986425000073 |
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| author | Julian Larkin Tudor Munteanu Emma Dolan Daniel J. Costello Kieron Sweeney Ronan Kilbride Peter Widdess-Walsh |
| author_facet | Julian Larkin Tudor Munteanu Emma Dolan Daniel J. Costello Kieron Sweeney Ronan Kilbride Peter Widdess-Walsh |
| author_sort | Julian Larkin |
| collection | DOAJ |
| description | The insula can generate seizures which mimic frontal, temporal and parietal epilepsies making electroclinical localization difficult. We report the case of a twenty-one-year-old woman who presented with seizure semiology of a left-sided painful somatosensory aura, progressing to bilateral tonic posturing and complex manual automatisms. She described a painful sensation and weakness affecting her left side following the offset of a seizure, with the pain consistenly outlasting the weakness. This would last from hours to days depending on the severity and duration of the seizure. Stereo-electroencephalography (SEEG) demonstrated seizure onset in the limen of the right insula. Extra-operative stimulation of the insula reproduced the clinical symptoms. She underwent radiofrequency thermocoagulation (RFTC) which has resulted in a significant reduction in seizure frequency. This case report describes a lateralized painful Todd’s phenomenon as a feature of insular epilepsy confirmed by SEEG and extra-operative stimulation. |
| format | Article |
| id | doaj-art-ce54825628584b608223714e0698e9bf |
| institution | Kabale University |
| issn | 2589-9864 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Epilepsy & Behavior Reports |
| spelling | doaj-art-ce54825628584b608223714e0698e9bf2025-02-10T04:34:46ZengElsevierEpilepsy & Behavior Reports2589-98642025-03-0129100747Painful Todd’s: Post-ictal painful hemiparesis as an identifier of insular epilepsyJulian Larkin0Tudor Munteanu1Emma Dolan2Daniel J. Costello3Kieron Sweeney4Ronan Kilbride5Peter Widdess-Walsh6Strategic Academic Recruitment Doctor of Medicine Programme RCSI University of Medicine and Health Sciences in Collaboration with Blackrock Clinic Dublin Ireland; Department of Neurology and Clinical Neurophysiology, Beaumont Hospital, Dublin 9 Ireland; Corresponding author at: Department of Neurology and Clinical Neurophysiology, Beaumont Hospital, Dublin 9, Ireland.Department of Neurology and Clinical Neurophysiology, Beaumont Hospital, Dublin 9 IrelandDepartment of Neurology and Clinical Neurophysiology, Beaumont Hospital, Dublin 9 IrelandEpilepsy Service, Cork University Hospital & College of Medicine and Health, University College Cork, Cork, IrelandDepartment of Neurosurgery, Beaumont Hospital, Dublin 9 IrelandDepartment of Neurology and Clinical Neurophysiology, Beaumont Hospital, Dublin 9 IrelandDepartment of Neurology and Clinical Neurophysiology, Beaumont Hospital, Dublin 9 IrelandThe insula can generate seizures which mimic frontal, temporal and parietal epilepsies making electroclinical localization difficult. We report the case of a twenty-one-year-old woman who presented with seizure semiology of a left-sided painful somatosensory aura, progressing to bilateral tonic posturing and complex manual automatisms. She described a painful sensation and weakness affecting her left side following the offset of a seizure, with the pain consistenly outlasting the weakness. This would last from hours to days depending on the severity and duration of the seizure. Stereo-electroencephalography (SEEG) demonstrated seizure onset in the limen of the right insula. Extra-operative stimulation of the insula reproduced the clinical symptoms. She underwent radiofrequency thermocoagulation (RFTC) which has resulted in a significant reduction in seizure frequency. This case report describes a lateralized painful Todd’s phenomenon as a feature of insular epilepsy confirmed by SEEG and extra-operative stimulation.http://www.sciencedirect.com/science/article/pii/S2589986425000073Insular epilepsyTodd’s paresisStereo electroencephalographyCortical stimulation |
| spellingShingle | Julian Larkin Tudor Munteanu Emma Dolan Daniel J. Costello Kieron Sweeney Ronan Kilbride Peter Widdess-Walsh Painful Todd’s: Post-ictal painful hemiparesis as an identifier of insular epilepsy Epilepsy & Behavior Reports Insular epilepsy Todd’s paresis Stereo electroencephalography Cortical stimulation |
| title | Painful Todd’s: Post-ictal painful hemiparesis as an identifier of insular epilepsy |
| title_full | Painful Todd’s: Post-ictal painful hemiparesis as an identifier of insular epilepsy |
| title_fullStr | Painful Todd’s: Post-ictal painful hemiparesis as an identifier of insular epilepsy |
| title_full_unstemmed | Painful Todd’s: Post-ictal painful hemiparesis as an identifier of insular epilepsy |
| title_short | Painful Todd’s: Post-ictal painful hemiparesis as an identifier of insular epilepsy |
| title_sort | painful todd s post ictal painful hemiparesis as an identifier of insular epilepsy |
| topic | Insular epilepsy Todd’s paresis Stereo electroencephalography Cortical stimulation |
| url | http://www.sciencedirect.com/science/article/pii/S2589986425000073 |
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