Focal Neurological Deficit Following a First Afebrile Seizure in a Child: A Case of Todd’s Paralysis
Javier Oro Fresquet1*, Sara Hernández Muela2
1Specialist in pediatrics and pediatric critical care medicine at IMED Valencia, Spain.
2Pediatric Neurology Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain.
*Corresponding Author: Dr. Javier Oro Fresquet, Specialist in pediatrics and pediatric critical care medicine at IMED Valencia, Spain.
https://doi.org/10.58624/SVOAPD.2026.05.028
Received: August 11, 2026
Published: September 14, 2026
Citation: Fresquet JO, Muela SH. Focal Neurological Deficit Following a First Afebrile Seizure in a Child: A Case of Todd’s Paralysis. SVOA Paediatrics 2026, 5:5, 180-185. doi: 10.58624/SVOAPD.2026.05.028
Abstract
Todd’s paralysis, also known as postictal paresis, is a transient focal neurological deficit that may occur following an epileptic seizure and can closely mimic acute ischemic stroke. We present the case of a 3-year old boy with no significant medical history, apart from multiple food allergies, who presented after a first afebrile generalized seizure followed by transient left-sided hemiparesis. Given the focal neurological deficit, an acute cerebrovascular or structural intracranial process was initially suspected, prompting activation of the stroke pathway and urgent neuroimaging. Cranial computed tomography and subsequent brain magnetic resonance imaging showed no evidence of hemorrhage, infarction, or other intracranial pathology. Further investigations, including laboratory testing, cerebrospinal fluid analysis, microbiological studies, respiratory viral testing, and urine toxicology, were unrevealing. The patient’s motor deficit progressively improved and completely resolved within 24 hours. Electroencephalography demonstrated generalized epileptiform abnormalities, supporting an underlying epileptic disorder. The patient was subsequently treated with levetiracetam and referred for pediatric neurology follow-up. This case highlights the importance of recognizing Todd’s paralysis as a potential stroke mimic in children presenting with focal neurological deficits after a seizure.
Keywords: Todd’s paralysis, Postictal paresis, Pediatric seizure, Stroke mimic