A neurologist's perspective on Sen. Kennedy's seizure

We all wish Senator Kennedy well... .
Reports are out that he suffered a seizure this morning link...

At this point, the details are limited.... but I will try to guess as to possible causes, and answer people's questions if they have any.

If you have ?s.. ask below and I will answer there or update the diary to answer whatever ?s you have

The fact he is allegedly talking now is good news.. that means the seizure was not too hard to control and he has most likely recovered. certainly, he is not in the intensive care unit on a ventilator.  The next day will investigate why he had a seizure. Likely he is now already on an-antiseizure medication, so the chances of another seizure in the next few days would be pretty low...

Here is a link to the Epilepsy Foundation.. Feel free to donate if you want!

What is a seizure?
A seizure is a series of symptoms that someone has due to abnormal electrical discharges in the brain.  All brain cells talk by electrical signals.  When the signals get jumbled, a person can suffer a seizure.  Anything that injures or irritates the cerebral cortex (the brain cells or neurons near the surface of the brain) can trigger a seizure.

What symptoms does it cause?
It depends on what part of the brain is involved.  People generally think of "grand-mal" seizures which cause whole body shaking, unconsciousness, and biting one's tongue.  But, there are many types. A partial seizure involves only a portion of the brain and can cause staring spells, seeing weird lights, or other symptoms.  The seizure can last a few minutes.. the effects can last a few hours until that part of the brain fully recovers.

Why would someone suffer a seizure?
Assuming Senator Kennedy had no history of seizures, the most likely cause of new onset seizures in someone his age would be a stroke. It can caused be an old stroke or new stroke and doesn't have to be from a large stroke.  (i.e. if he had a small stroke a few years ago, it can make the brain irritable and cause a seizure.). An old stoke mini-stroke causing the Senator's seizure may be most likely, as we know he had a blocked carotid artery last year prior to surgery. A brain hemorrrhage would be another cause, but I'm guessing that isn't the case here or they may have announced that already (it would have been apparent on the first CT scan. If he is diabetic, low sugar can cause a seizure.

What if he didnt have a stroke?
Other causes could include a brain tumor, alcohol (or benzodiazepene such as valium) withdrawal, large electrolyte (salt) imbalances, rare infections, injury (from prior concussion, contusion ,etc...).  Some people have seizures for no apparent cause. The causes in children are different but I assume he had no prior history of seizure

What if Sen. Kennedy had a history of seizures?
This is possible.. I doubt we know his full medical history.  If he had a prior history of seizures, that would not be so bad... in fact it would make this less worrisome because then it wouldnt be from a new (potentially bad cause).  People with seizures can have recurrent seizures for no good reason at all, noncompliance with medication, fever/infection, or if another medication made the anti-seizure medication less likely.  Again, some people arent treated after one seizure.. so it is possible he had a seizure 5 years ago, wasnt treated and then this happened (in which case he would now go on a medication).

Is it serious?
Usually seizures can be controlled by medication... It is serious but often treatable.

How is it treated?
There are many anti-seizure medications that are effective.  Many people aren't treated after their first seizure as many times it never recurs.  The medications are not a 100% guarantee against a future seizure but are pretty effective.

What is worst case scenario?
Worst case would be he had a new brain tumor.

Is that likely?
i would guess no.. likely he had a brain scan last year when he had his carotid artery surgery.  The fact that nothing showed up then makes a new tumor less likely (but not impossible).

Will the seizure cause permanent damage?
usually not.. Damage would occur after very prolonged seizures which cannot be controlled by medication.  If anything, the cause of the seizure is more related to his prognosis (i.r if someone had a seizure due to a tumor, the prognosis would be not so good.. if it was from an old mini-stroke, the damage may be minimal and allow normal function and a full recovery.

•  tips

  by njhoo on Sat May 17, 2008 at 12:32:16 PM PDT

  •  Thanks for the info...

    ...for us laypeople

    by there will be blood on Sat May 17, 2008 at 12:33:53 PM PDT

  •  Excellent service

    I'm sure this will answer many questions in the community.  Hope the FP posters link to your diary for those who want to know more.

    by Dallasdoc on Sat May 17, 2008 at 12:37:52 PM PDT

  •  Great diary.

    Thank you.

    by sheddhead on Sat May 17, 2008 at 12:59:22 PM PDT

  •  thank you

    btw, I'm an MS-III and neurologist wanna be myself :-)

    by emidesu on Sat May 17, 2008 at 04:06:26 PM PDT

    •  good luck to you,,,

      any idea where you want to go for residency?

      by njhoo on Sat May 17, 2008 at 04:17:32 PM PDT

      •  Thanks!

        I live in Philly and my fiance is looking to start a business so I probably need to stay local.  But I guess if I had a choice of where to be limited it would certainly be here!  At this point I'm aware of the big names- Jefferson, Temple, Penn, Drexel... and I guess I'll see more as I rotate.
        I'm so glad to run into you here :-)

        by emidesu on Sat May 17, 2008 at 10:48:50 PM PDT

  •  As one whom suffers from siezures,

    I empathize with Sen. Kennedy and the entire Kennedy family.  They are going through a very difficult time right now.

    McCain housing policy shaped by lobbyist

    by Nonconformist on Sun May 18, 2008 at 12:06:21 PM PDT

•  I had a seizure about 20 years ago

  Never had another, no problems from it or anything. I almost forgot it had ever happened.

  Of course, I was a teenager then, not 76.

  by lauramp on Sat May 17, 2008 at 12:37:39 PM PDT

  •  I had one last Saturday

    while in the ER for treatment of a severe nosebleed.  I had an angioplasty Easter weekend and have been on Plavix since then, so I don't clot very well.  The nosebleed left me a couple pints low on blood and I had a vasovagal reaction -- at least that's what the ER doc said after they did a CT scan.

    by 3waygeek on Sat May 17, 2008 at 12:53:18 PM PDT

•  Thanks for the information

  My grandfather had a stroke a few years back and it started as a seizure.  They had trouble diagnosing the stroke because nothing showed up on the cat scan.  Therefore he didn't get the treatment that he needed in time.
  Would the fact that Kennedy was lucid and made a phone call after the seizure be a good sign?  Would it also indicate that it was more likely not a stroke, but simply a seizure?

  by Snickers77 on Sat May 17, 2008 at 12:39:07 PM PDT

•  Useful and comforting

  This is the best and most helpful analysis I've read on Sen. Kennedy's illness.  During a confusing and distressing news day, your breakdown is most welcome.  

  by north aufzoo on Sat May 17, 2008 at 12:39:09 PM PDT

•  Remember that SC chief justice John Roberts

  has a seizure last summer on a dock in Maine. He was hospitalized for a couple of days and then discharged. IIRC, he had had at least one seizure several years earlier. If the cause of his seizure was diagnosed, it was not disclosed to the public.

  by alba on Sat May 17, 2008 at 12:47:22 PM PDT

  •  Actually,

    John Roberts had two seizures on two separate occasions, thus officially diagnosing him as an epileptic.

    McCain housing policy shaped by lobbyist

    by Nonconformist on Sun May 18, 2008 at 12:10:56 PM PDT

•  Thanks ... and a question

  I know that mini-strokes can cause very minor and transient symptoms.  (A friend of mine had one a few weeks ago, spent a couple of nights in the hospital for evaluation, and was seemingly back to normal within a week.)  

  Is it possible to have a TIA or mini-stroke while sleeping that doesn't even wake one up, and therefore isn't detected?

  by leevank on Sat May 17, 2008 at 12:50:06 PM PDT

  •  yes in a sense...

    we see patients who have had what looks like an old stroke on a MRI  but never had symptoms.. if it occurred in sleep and resolved before they woke up that would be a possible explanation.

    obviously there is no way to prove someone had a TIA when asleep unless it persisted when they woke up

    by njhoo on Sat May 17, 2008 at 12:56:42 PM PDT

•  Idiopathic seizures

  are also a possibility, as in the case of Justice Roberts, but much less likely given Kennedy's prior medical history.

  Question:  The Boston Globe is reporting that it was not one, but two seizures.  He had one for which the EMT's were called to his house, and the Boston Globe reports that he had another during transport.  Does it make a difference in what you are looking to rule out or what the likely cause might be that he had not one, but two seizures?  Also, include the fact that the patient seems to have return to normal functioning, i.e. able to make a phone call, after the second seizure?

  by Casey Morris on Sat May 17, 2008 at 12:50:17 PM PDT

  •  two seizures doesn't change much

    the above causes can cause multiple seizures until treated,  Sometimes, patients get a "cluster" of seizures.  

    Again the fact that he recovered is the most important part because he should now be on a medicine if he wasn't already (likely Dilantin).. after the first seizure at home, he likely wasn't fully treated which may explain why he had another.

    by njhoo on Sat May 17, 2008 at 01:01:51 PM PDT

•  Yes, thank you so much

  for this informative post. Sen. Kennedy is in our thoughts and prayers. I find myself thinking about all of the Kennedys and what they have meant to our country and that he is the "last" of the JFK generation and that makes me very sad. I know there's a whole other generation, but not like him. I so want him to be around to see Sen. Obama sworn in on 1/20/09 should we be so fortunate for that to happen. He really is the liberal lion of the senate. Please don't leave us yet, Teddy.

  by lilysnana on Sat May 17, 2008 at 12:53:21 PM PDT

•  Oh, and thanks so much for doing this...

  public information Q and A for concerned folks here.  Very, very kind of you to do so.

  You are doing much to reverse my personal experiences that neurologists are prima donna assholes who usually score 100% in the science part of medicine, but a 0% on the art part of medicine.

  Unfortunately in my family and myself, I have had many, many, many interactions with neurologists (brain aneurysm, brain tumors, stroke) that have been less than, shall we say, fully cognizant of the fact that the brain is attached to an actual human being.

  As I said, you are doing much to reform my general opinion today.  Very kind of you to offer to help. Thanks again.

  by Casey Morris on Sat May 17, 2008 at 12:55:06 PM PDT

•  thanks Doctor !

  I have a friend, 59 yrs old, in this kind of trouble, taking meds and he's been 100% fine for 3 years.

  (Along the lines of too much information: He claims he can get it up every day now!)

  So my question is, does anti-seizure medication usually act this way, is it wood-neutral or does it indeed free up the id?  Or, is my friend just playing it out?

  by ezdidit on Sat May 17, 2008 at 12:58:38 PM PDT

  •  haven't heard that before...

    then again, usually most neurologist dont talk about erectile function with their patients, so it could have happened and nobody ever mentioned it to me.

    by njhoo on Sat May 17, 2008 at 01:05:11 PM PDT

  •  Don't let Bill O'Reilly hear you say

    "playing it out." Seems that isn't terminology to which he reacts well. :-)

    by bwintx on Sat May 17, 2008 at 01:31:17 PM PDT

•  You have to remember his age, and the

  fact that he's very overweight.

  I hope he hasn't had a stroke, but we won't know that no matter what they say.  

  by nupstateny on Sat May 17, 2008 at 01:00:36 PM PDT

  •  He's not that big, he just has chubby cheeks. nt

    by AmericanRiverCanyon on Sat May 17, 2008 at 03:27:00 PM PDT

    •  Pleasantly plump..:) n/t

      by nupstateny on Sat May 17, 2008 at 04:08:46 PM PDT

•  Kennedy is one of the good guys

  demonized by the media way back before Fox.  He had an accident. He probably shouldn't have been with that woman, but he could have been just being his nice self and offered her a ride home.

  Anyone who has been in an icy river, especially unexpectedly, late at night, knows he was lucky to get out and the bravest of souls have to come up for air.  People who are drowning fight you.  I feel that he did the best he could and was another victim of a media that destroyed democrats anyway they could. He survived, but he would have been president if not for the accident.  This country would be better off, if he had been president.

  Notice they never mention McCain owning all those houses, but give Edwards hell over a haircut.

  by relentless on Sat May 17, 2008 at 01:55:10 PM PDT

  •  Read the Relentless Diary

       Our Komrade displays a bescumbered wit, if not razorian grammar.

    by alain2112 on Sun May 18, 2008 at 06:01:59 PM PDT

•  you forgot epilepsy!

  I was surprised to see you didn't list epilepsy in there at all, even though you had an earlier link to the Epilepsy Foundation.

  Glad you wrote this, though -- I have epilepsy and people are so mis/uninformed. EFA doesn't educate enough.

  Anyway -- probably not as likely in this situation, or they wouldn't have life-flighted him, since they'd already know what the problem was.

  For the laypeople -- epilepsy includes any of the different types of seizures njhoo mentioned. Mine is idiopathic -- no identified cause -- though they suspect it's something genetic.

  I feel bad for him though -- biting your tongue hurts like hell. If he had a grand mal, he probably did that. Even he were feeling better, no way he could eat at a luncheon or hold long conversations without lisping.

  Feel better, Senator!

  by michelina on Sat May 17, 2008 at 02:04:36 PM PDT

  •  didnt mention epilepsy because

    not likely cause of seizures in elderly... but yeah i probably should have used that word at least once...

    you're right that the public doesnt get enough info on this..thanks for the comment

    by njhoo on Sat May 17, 2008 at 04:16:53 PM PDT

•  thanks for this, Dr. njhoo

  I appreciate the Q/A format.  It's much more informative than anything else I can find, although I know it's all conjecture at this point.

  Thanks for sharing your area of expertise with us.

  by Dem in the heart of Texas on Sat May 17, 2008 at 08:52:55 PM PDT

•  This is why I love DKos. Something happens, and

  then someone who actually knows what they're talking about steps in to provide some context (but doesn't claim to have all the answers).  So not like most media outlets.

  Thanks for taking the time.

  by lineatus on Sat May 17, 2008 at 08:56:30 PM PDT

•  Thanks for the informative diary!

  I'm late to the diary, but I still wanted to thank you. I have a 10 year old with epilepsy (absence seizures, controlled by Depakote)and that was all I could think about when I heard about Sen. Kennedy's seizure. Very interesting to hear the other possible causes.

  by cerulean on Sun May 18, 2008 at 03:52:02 PM PDT