Sunday, May 18, 2008

Ted Kennedy's Seizure

Ted Kennedy, age 76, was rushed to Massachusetts General Hospital in Boston yesterday after suffering a seizure at his Cape Cod home. The first report was that he had suffered from a stroke, but that has been ruled out. He is reportedly doing fine and has no after-effects from the seizure, although he is still undergoing tests in the hospital.

In medicine, when I hear of a first seizure occurring in an adult, the first thing to make sure of is that it is a true seizure rather than a fainting spell (syncope). A seizure usually causes loss of consciousness and it is usually followed by a short period of confusion and feeling dazed. In contrast, a person will usually awaken clear headed after a fainting spell. I presume Ted Kennedy's episode was witnessed by family or friends and that he had some type of muscle shaking or sensation that identified it as a true seizure.

Once it has been identified as a true seizure, looking for a cause is the next order of business. Causes of seizures in adults are strokes, brain trauma, infection, medication toxicity, alcohol or drug withdrawal, or tumors (either benign or malignant). Some times an old brain injury from trauma can cause seizures many months or years later. The diagnosis of epilepsy requires two seizures, at least 24 hours apart. One third of people with a single (unprovoked) seizure will develop a second one.

Senator Kennedy will probably undergo the following tests:
  • Routine lab tests
  • Lumbar Puncture to examine his cerebrospinal fluid
  • Drug and alcohol screening
  • Electroencephalography (EEG)within the first 24 hours
  • Sleep deprived EEG if the first one is negative
  • MRI scan
The above tests should give Senator Kennedy and his physicians the answers they are looking for. There is controversy about whether to treat a single seizure with medication.

Hopefully they will find the cause and be able to determine if he needs seizure medication. He will not be able to drive for at least a year.


number said...
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Beastarzmom said...

I think it might be a good thing he's not driving for another year. Unfortunate about the seizure, but I'm looking at the silver linings here...

Toni Brayer MD said...

To anon and beastarzmom: Thanks for your comments.

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ERP said...

My comment is that we see new onset seizures in the ER ALL THE TIME. If it is an isolated, short seizure and the CT and labs we get in the ER are normal, we usually discharge them to see a neuorologist is a day or two to get an outpatient MRI and EEG. Usually we don't start antiepileptic drugs. Of course the senator gets airlifted and admitted for the million dollar inpatient workup. Money usually could be saved by doing this as an outpatient.

Rich said...

Maybe his brain is pickled from all that booze?

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Anonymous said...

You were exactly right about one of the siezure possabilities being a maligant tumor, very sad for his family and freinds.

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