A new light on an old disease

When was the last time you heard anyone talk about epilepsy? I thought so. But now that Justice John Roberts has had a second major seizure, he fits the criteria for epilepsy and a determination must be made as to whether he requires medication:

“I would recommend taking medication,” Dr. Barkley said. “The intervals tend to get shorter and shorter, and people tend to have recurrent seizures.”

He explained: “The brain learns from practice. The more you practice, the better you get, whether you’re playing the piano or having seizures. The more you have, the more you’re going to have. Most neurologists feel that the best way to intervene is to get the seizures under control as quickly as possible.”

Dr. Robert S. Fisher, director of the epilepsy center at Stanford University and a past president of the American Epilepsy Society, said: “In my view, it would be reasonable not to treat. It sounds like he went 14 years between seizures, and that’s a lot of pills to take to prevent the next seizure 14 years from now. The new ones are better than the old ones in terms of side effects, but they all have potential side effects and risks.”

Doctors say a complete medical workup is needed to find out if the two reported seizures were really the only ones that have occurred, because people with epilepsy can have mild seizures that they are not aware of. Neurologists often ask family members whether patients have certain symptoms, like daydreaming or blanking out for brief intervals, and not snapping out of it when others try to speak to them. Other symptoms may include dizziness, sensations in the stomach, feelings of déjà vu or noticing odd smells or tastes in the mouth — experiences that the patient may not recognize as seizures.

Often, Dr. Barkley said, a patient will report having had one seizure, but when asked about these other symptoms will say, “Oh, yes, that happens all the time.”

If such symptoms are frequent, it may sway the decision in favor of treatment.

Dr. Cynthia L. Harden, a professor of neurology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, said it would be important to perform brain-wave studies to look for abnormal electrical activity in the brain, to get an idea of where the seizures may be starting and how frequent they are.

Dr. Harden said such studies during sleep were especially useful, and could help in making the decision about treatment. In people with epilepsy, Dr. Harden said, sleep deprivation can be a potent cause of seizures. The chief justice has had a busy schedule recently, including a two-week trip to Europe during which he attended conferences and taught.

Unless he can be shown to have had multiple milder seizures, this would be a tough call. On the one hand, you don't want to take medication unless absolutely necessary, but if the next seizure takes place, say, behind the wheel of a car, the consequences could be catastrophic for himself and others.

One would hope that as with any disease afflicting someone high-profile, Roberts allows his experience to enable shining a brighter light on a disease that is not uncommon, but is rarely discussed. One would also hope that the next time a case involving health care comes before him, he reflects on the excellent care he receives from the United States government, and on whether all Americans should be able to obtain the level of care he is receiving.