Seize the day

Sunday, May 18, 2008

When one of our political leaders becomes ill, it makes headline news. Senator Ted Kennedy suffered a seizure on Saturday, May 17, 2008 which led to a quick visit to Cape Cod Hospital and a medical helicopter flight to Massachusetts General Hospital, home base for Harvard Medical School. On May 20 doctors announced that a tumor had been identified as the cause of the seizure Tissue samples taken at biopsy reveal that Senator Kemnedy has a malignant glioma of the parietal lobe of his brain.

Seizures occur when the brain becomes irritable and abnormal electrical firings cause alterations in normal brain function. Usually, the patient becomes temporarily unresponsive and the exact location of the electrical short circuits will determine what abnormal physical findings are witnessed. If they involve the part of the brain that deals with movement, there may be rhythmic shaking or jerking. The seizure may involve just a mild absence or staring spell. It may be preceded by an aura in which the patient knows that a seizure is about to occur. There may be a post-ictal or recovery phase, in which the patient slowly returns to normal function as the brain resets itself. There are many different variants of seizures, and eventually a neurologist will get involved with the diagnosis and treatment.

Seizures are pretty common. The chance of having a seizure in your lifetime is almost 10%. They can have a variety of causes ranging from head injury (it’s not uncommon to witness a seizure after a patient has been knocked unconscious) to electrolyte abnormalities to drug abuse and alcohol withdrawal. Bleeding in the brain, tumors, and stroke are also associated with seizures. But many times the cause of a seizure is never found.

The initial evaluation of the patient begins with the history of what happened, examination of any potential associated risk factors for a seizure, and a physical examination. Presuming that this is normal, screening blood tests are done including a complete blood count and electrolytes, glucose, and kidney function tests. A CT scan of the head will look for bleeding or masses, and an EKG and heart monitor may reveal heart rhythm disturbances. If infection is suspected, a lumbar puncture may be considered.

After that, if the patient has returned to normal and all the tests are normal, a philosophical discussion has to take place. Everybody is potentially given a freebie; it may be time to go home with follow up arranged for an EEG (electroencephalogram or brain wave tracing) to look for a potential electrical short circuit as the cause of the seizure. Depending upon the result, there may or may not be a need for medications to prevent future seizures.

This is a trying time for the patient and family. The doctor has confirmed what they fear, a seizure. The question about epilepsy is asked, but the two terms are not synonymous. One can have a seizure and not have a seizure disorder. Kids have febrile seizures. Alcoholics have seizures when they withdraw from drinking. Patients with low sodium levels in their blood can seize. Low blood sugar causes seizures. Patients with minor head injuries can seizure when first hit. Or, seizures may signal a serious problem.

In Senator Kennedy’s case, the seizure was a presentation of a severe condition- a malignant tumor of the brain. According to news sources, preliminary biopsy results indicate that the tumor is a glioma, the most common type of malignant brain tumor, and is located in the left parietal lobe of the brain. Further examinations and tests are required to determine the exact course of treatment for someone with a glioma, but radiation and chemotherapy are two commonly used treatment modalities.

For the majority of people who experience a single seizure, it becomes an inconvenience. After tests come back normal. They can return to life as they know it. Unfortunately, medical tests are done to look for bad things and sometimes they are found. The seizure becomes a life altering and sometimes, as in Sewnator Kennedy’s case a life threatening event.

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