Unilateral Fits Affecting Limb(s) or Face

Abstract

Faced with a complaint of unilateral fit(s) the first task is to establish whether the patient has had similar events before. The next is to find out whether the seizure(s) was (were) motor or sensory, or both. Motor seizures may be tonic or clonic, or may consist of a brief tonic phase which is followed by clonic twitchings. It is useful to learn whether or not there was a jacksonian march, which is a slow progression of clonic twitching or paresthesia, usually from proximal to distal parts of the limb. If the arm is affected, the motor or sensory phenomena may spread to the face or to the ipsilateral leg, while the trunk is usually spared. Many patients can clearly describe the progressive march of the jerks or the paresthesia, but very few can describe how the fit ends after a few minutes. There may or may not be Todd’s paralysis, i.e., weakness and clumsiness of the affected limb(s) for a period of up to half an hour. Todd’s paralysis can also follow a purely sensory jacksonian march. When the seizure and the postictal paresis are over, the patient frequently has only minimal symptoms or neurologic signs, or none at all, which is why he will not see the doctor after the first fit, but rather dismiss it as a trivial event.