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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.

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Comment Preferences

  •  Thank you! Not only to help us understand (4+ / 0-)
    Recommended by:
    SoCalSal, tharu1, wilderness voice, Lujane

    former Sec. Bryson, but for our own sake or those we know.

    A lost battle is a battle one thinks one has lost. ~ Jean-Paul Sartre

    by ParkRanger on Thu Jun 21, 2012 at 09:48:00 AM PDT

  •  Would Sec. Bryson be eligible for disability? (1+ / 0-)
    Recommended by:
    Lujane

    If his seizures are severe, I don't think he'll be able to work anymore.

    A thief thinks everybody else is a thief; a liar thinks everybody else is a liar; and a Republican thinks everybody else is as selfish and heartless as they are.

    by rubyduby7 on Thu Jun 21, 2012 at 10:26:16 AM PDT

    •  Without knowing his medical records... (1+ / 0-)
      Recommended by:
      Lujane

      I wouldn't know.

      There are millions of people in the world who live with epilepsy/seizure disorder who lead perfectly normal lives and who work in every profession.  Most people don't need to be put on disability.

      I'm very strict when it comes to approving disability for people - as long as your seizures are well controlled but you have no other abnormalities - I'm not the doctor who will approve you for disability if you don't qualify.

    •  I'm not sure what disability you're referring to, (0+ / 0-)

      but we have a disability insurance policy on my husband and it will not pay out after he turns 65.  So at 68 Bryson may not qualify for disability even if the condition might be a qualifying one.

  •  I had a friend in his 40s... (2+ / 0-)
    Recommended by:
    wilderness voice, Lujane

    ...who died from glioblastoma multiforme.  A whole team of surgeons agreed he had absolutely no chance and that he had a few months left.  That's one cancer that is a certain death sentence.  He left a wife and 2 teenagers.

  •  Thanks (3+ / 0-)
    Recommended by:
    wilderness voice, PeterHug, Lujane

    Thanks for a very informative article.

    Penny in the tip jar.

  •  I had a seizure 13 years ago. (2+ / 0-)
    Recommended by:
    Lujane, BachFan

    Walking in a street market on a sunny Sunday morning.

    The only precursor was a tunneling of the vision ( which I had experienced also 2 weeks prior), and I said I was going to sit down at a cafe cos I felt unwell.

    Next thing I remember is coming to in the ER of a local hospital, maybe an hour later. Apparently I fell over and had an epileptic type fit.

    I spent three days in hospital, had ECG's, EEG,s X Rays, CAT scans and all sort of alphabet treatments, but no cause was ever found. Subsequently had a brain MRI, (nice to be able to prove you have a brain) and nothing there either.

    Since then it has never re-occurred, but for the first year or so I was very nervous when driving ( I gave up my motor cycle completely), and if anything made my eyesight abnormal, I would feel the worry. Enough to stop the car, and sit on the hood until it passed.

    I guess sometime the brain just has a short circuit.

    PS - as this was in Europe, my co pays were maybe $100.  Eat your hearts out.

    •  You might have had convulsive syncope (2+ / 0-)
      Recommended by:
      Lujane, peterfallow

      And not an epileptic seizure.  Convulsive syncope is quite common and often confused to be an epileptic seizure due to the way it looks.  Basically, after one faints (there is often preceding symptoms of tunnel vision, muddled hearing, lightheartedness before the fainting) there is a transient period of time when the brain does not get adequately perfused during which people often have what are called myoclonic jerks of their extremities that appear to look like jerking movements/twitching. The movements are often confused to be seizures. When a person comes to, they pretty much bounce back to normal pretty quickly.

  •  Son has a seizure disorder (0+ / 0-)

    Has had two Tonic-Clonics in the past two years, several Complex Partial seizures.

    I have a strange question if you read this, Doctor. Before he had his first tonic-clonic, the streetlights would go out when he passed under them. Every time.

    He was driving my car last week (It's been since March that he's had the headache, deja vu- so he's legally safe to drive.) The thing is, the streetlight went out and the car died. I've searched the message boards about epilepsy/ seizure disorders, found nothing about a seizure patient and electrical currents such as streetlights. Am wondering if it's out of the realm of possibility that the car dies due to a jolt in the electricity in his brain.
    The streetlight are a definite- it happens every time he is under them.

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