Neurologist offers insight into seizure disorder

Last month, Commerce Secretary John Bryson, 68, resigned from his Cabinet post after suffering a seizure while driving, resulting in two car crashes. To get a better understanding of this condition, we turned to Dr. John Ebersole, a national authority on seizure disorders and director of the University of Chicago Adult Epilepsy Center. Here's what the neurologist had to say:

Q. John Bryson's two crashes in the Los Angeles area were frightening. Can anyone just black out?

A. Yes, anyone under the right circumstances can faint or have a single seizure with loss of consciousness, but the Bryson story of repeated car crashes is very strange. There are clearly some missing pieces to this story, such as whether he had a history of previous seizures and, if not, upon what evidence are his doctors making this diagnosis. Without further medical details, I'd have to say that it is very unlikely that a single seizure could account for the entire scenario.

Q. That's a relief. So who is a candidate for seizures?

A. Generally, there are two times in our lives when the onset of seizures is most likely: When we are a child and after age 60. Seizures that begin late in life are usually related to existing vascular disease. Strokes or hemorrhages in the brain are a leading cause for the development of epilepsy in the elderly. Seizures can sometimes be the initial presentation of a small stroke that had gone undetected.

Q. In the aftermath, Bryson's neurologist said he had a complex partial seizure. Can you explain what that is and how it works?

A. Complex partial seizures are a type of focal seizures that occur in one part of the brain and affect behavior and one's ability to respond appropriately to your environment. Some people get a feeling or warning immediately before a seizure, which is called an aura. But typically, only when the seizure activity spreads to both sides of the brain does a person have a full-blown convulsion. So, in Bryson's case he could have had a partial seizure when he hit the first car ... and then a second and bigger one with loss of consciousness when he hit the second car.

Q. Do certain people have a predisposition for seizures?

A. In the case of older patients, the major risk factors would be existing vascular disease, high blood pressure, heart disease or a strong family history for cerebrovascular disease and stroke. In general, the healthier you are, the less likely you are to have an increased risk for the onset of seizures in later life.

Q. You mention genetics. Do you think that environmental factors play a part in these diseases?

A. Many types of childhood-onset epilepsy can be genetic. This is less so for adults and the elderly, except as I said previously for having a genetically based, increased predisposition for vascular disease and thus stroke

Q. How are seizures different from epilepsy? Are there different degrees?

A. Anyone can have a seizure under the right circumstances. Many individuals only have one seizure in their life. Accordingly, after a single seizure we do not say that the person has epilepsy. Epilepsy is a condition of chronic recurrent seizures. It is not a matter of degree or intensity; it is a matter of recurrence, having repeated seizures over time.

Q. What progress have we made in treatment or medication or both? Is quality of life better today for these folks?

A. Today we have many more drugs to treat epilepsy than we did in the past. Most have fewer side effects than our older drugs. Fortunately, seizures in the majority of patients can be controlled with medications, and they can lead a normal life. Unfortunately, about a third of patients continue to have some seizures despite taking anti-convulsant drugs. For these patients, we now have other therapeutic options, such as epilepsy surgery to remove the epileptic brain tissue and various forms of electrical stimulation of the brain or its nerves to either help prevent or to abort seizures.

Q. Are there things people can do to keep their brain healthy?

A. If you have high blood pressure, have high cholesterol and are mostly eating fatty foods, doing all the crossword puzzles in the world isn't going to help.

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