TOPICS > Health

Chief Justice’s Seizure Raises Questions About Causes

July 31, 2007 at 6:15 PM EDT

GWEN IFILL: The chief justice is one of 25 million Americans who have had, or will have, a seizure at some point in their lives. Three million of those have epilepsy, which means they have suffered more than one seizure.

Here to tell us more is Dr. Susan Spencer, professor of neurology at the Yale University School of Medicine.

Welcome, Dr. Spencer.

DR. SUSAN SPENCER, Professor of Neurology: Thank you.

GWEN IFILL: The term we have heard today is benign idiopathic seizure. Define that for us in English.

DR. SUSAN SPENCER: Well, a seizure is an episode of brain cells discharging excessively and an abnormal number of them discharging in unison. And there are many kinds of seizures, and they have a multitude of causes, so virtually anything that affects the brain can cause seizures with the right situation.

Sometimes, however, we are unable to identify a discrete cause, like a tumor or a stroke or an injury or the way the brain developed or other causes, and then we call it idiopathic, meaning we don’t have a defined cause. Some of the syndromes that cause seizures recurrently, which are defined as epilepsy, are not clearly defined as cause and also not associated with any other disturbances of the brain or an individual’s function. Some of the things…

Defining epilepsy

GWEN IFILL: I'm sorry. Pardon me, Dr. Spencer. One of the things that caught my eye, though, in the term benign idiopathic seizure is that benign sounds like it's not life-threatening. Is that a correct interpretation?

DR. SUSAN SPENCER: Well, I think that any seizure can be life-threatening, depending on how big it is and what situation it occurs in, but generally speaking the seizure will run its course. And I think the benign term refers more to the syndrome, meaning that there is no associated damage to the brain or change occurring in the brain or other neurologic or systemic illness or progressive problem, but the seizure is benign in itself and occurs, perhaps occasionally, without other manifestations of any disorder.

GWEN IFILL: Another definition for us, when we hear the word epilepsy, we think of a chronic disease. There are two episodes here that we know about, and that Justice Roberts first suffered a seizure 14 years ago and then again yesterday. Why is that epilepsy?

DR. SUSAN SPENCER: We define epilepsy as recurrent seizures, and so, technically speaking, after you have more than one seizure, you have epilepsy. That's just purely a definition.

GWEN IFILL: Is it unusual to have them so far apart, 14 years?

DR. SUSAN SPENCER: It is quite unusual and does occur in certain syndromes that may be inherited but are idiopathic, and we don't have a clear, defined genetic factor. And that can occur, although most causes of seizures tend to cause them a little more frequently without treatment.

Understanding triggers

GWEN IFILL: You mentioned the causes. I know that you were not involved in Justice Roberts' treatments, but is there a way of knowing if there is a trigger for these kinds of seizures?

DR. SUSAN SPENCER: There are, as I said, many causes of seizures. And then the question, of course, is why in any cause of seizure does the seizure occur at a certain moment in time?

Sometimes circumstances lower what we call the seizure threshold, and that can occur, for example, with lack of sleep. It can occur with fever. It can occur with certain medications or exposures. It can occur with changes in body chemistry and salt balance. So there are certain factors that may provoke the seizure occurring at a certain time in an individual who has seizures.

GWEN IFILL: Is it unusual for it to occur in mid life? He's fairly young by some standards, in his early 50s, but also people think of epilepsy either as a childhood disease or an elderly disease.

DR. SUSAN SPENCER: Well, epilepsy is, in fact, a childhood disease. More than 80 percent of seizures begin in childhood, but it can begin at any age. And even causes that are related to the way the brain has formed cannot manifest the seizures that might be associated with that until the second, third, fourth or even fifth decade.

Treating Justice Roberts

GWEN IFILL: When the seizures are so far apart as they were in this case, is there any obvious treatment?

DR. SUSAN SPENCER: The recommended treatment for epilepsy, which is more than one seizure, is generally to take medication to prevent recurrent seizures. Because this interval is unusual, it is a decision to be made in terms of taking medication on a daily basis to prevent a seizure, seeing how long of an interval went without any symptoms whatsoever. Nevertheless...

GWEN IFILL: That's all right. What were you saying?

DR. SUSAN SPENCER: Nevertheless, usually we recommend treatment if someone has had more than one seizure.

GWEN IFILL: And if you've had two, how much more likely is it that there will be another one? Like when you've had a stroke, it is apparently considered likely that you will then have another stroke. Is that true as well for seizures?

DR. SUSAN SPENCER: It certainly is, and the risk of having a recurrent seizure after one seizure is somewhat low, like in the range of 20 percent or so. But it goes up to well over 50 percent if an individual has a second seizure, and that's really the origin of the recommendation that treatment be initiated at that point.

GWEN IFILL: Dr. Susan Spencer of Yale University School of Medicine, thank you very much.