As an epileptologist and neurologist, I worry about all patients with new onset seizures. For adults who have new onset seizures, it is very important that they are followed closely by a neurologist.
I predicted last week upon hearing the news that Commerce Secretary John Bryson suffered from seizures that he would resign and today, my prediction became reality.
As a 68 year old male with new onset seizures, the most likely cause for such are either mass-lesions such as brain tumors or vascular anomalies or are related to hemorrhagic causes (i.e. brain hemorrhage).
Below the fold, I will explain to you what most likely will happen in terms of Secretary Bryson's workup.
Given the description of what happened last week when Secretary Bryson was involved in 3 motor vehicle accidents, it is likely that he suffered a partial seizure or parial seizures and was in a postictal state when the incidents occurred.
A partial seizure means that a part of the brain suddenly develops synchronous, rhythmic electrical activity in a part of the brain. This abnormal rhythmic activity has the potential to spread throughout the brain. That situation is called "generalization" or "secondary generalization" and often manifests clinically as a generalized tonic clonic seizure (aka grand mal seizures).
When someone has partial seizures, it is a sign of focal cerebral dysfunction in the area that the seizures occur. In an adult population, above age 40 - the dysfunction may be secondary to a mass pressing and irritating the substance of the brain that is impinged by the mass.
In the case of Secretary Bryson, he now must undergo an extensive workup to figure out what caused him to have his seizures. The first issue to deal with is how to prevent the seizures from occurring again. I am sure he is now on an anticonvulsant medication (probably something like Keppra). The second issue to deal with is figuring out whether or not Secretary Bryson has a particular brain abnormality that needs prompt attention. He will need to have an MRI of his brain without and with contrast dye to evaluate for tumors, vascular malformations, strokes and areas of the brain that may be congenitally abnormal (i.e. cortical dysplasia) or may have developed abnormalities over the years secondary to a remote injury (i.e. mesial temporal sclerosis).
The third issue to deal with is figuring out where in the brain is there signs of "irritability" and electrical dysfunction. This is performed via an electroencephalogram (EEG). The EEG is either routine or prolonged.
Once Secretary Bryson is on anticonvulsants, he will be less likely to have a subsequent seizure, however anticonvulsants do not cure the seizure disorder. Curative therapy depends on what the cause of the seizures are.
Should it be that Secretary Bryson has a brain tumor - he will likely need a biopsy to figure out what type of tumor it is. If it is a benign tumor, such as a meningioma, that is good - treatable via surgical resection (if it is in a place that is easily accessible). If it is a malignant tumor - then I fear for what will happen next. A particular malignant tumor that comes to mind that can occur in a 68 yr old male is something called "glioblastoma multiforme" - treatment is usually palliative in nature as the vast majority diagnosed with this particular glioma die within 5 years of diagnosis no matter the treatment (surgical resection, chemotherapy, radiation therapy).
Should it be that Secretary Bryson has a vascular anomaly such as an arteriovenous malformation - it may be treated via neurosurgical resection or endovascular coiling/stenting. Should it be that Secretary Bryson has another type of vascular anomaly - i.e. cavernoma (angioma) - that may just be followed with yearly imaging studies to see if it "grows" while he remains on anticonvulsants.
You will surely hear people malign Secretary Bryson for his seizures and discuss how President Obama should have known about these medical issues (look at Drudge right now and you will see for yourself how the rightwing is turning this into a political issue) but I would hope that my progressive brethren within this community not judge Secretary Bryson for events that he could not control.
I hope this diary is informative and educating and if any of you have had a seizure without getting a proper workup - please contact your doctor and make sure you are evaluated.