From Our 2007 Archives

Chief Justice John Roberts Has Seizure

10 Questions and Answers on Roberts' Seizure

By Miranda Hitti
WebMD Health News

Reviewed By Louise Chang, MD

July 31, 2007 -- U.S. Supreme Court Chief Justice John Roberts has left a Maine hospital after having a seizure yesterday afternoon at his Maine vacation home.

According to media reports, doctors said Roberts, 52, had a "benign idiopathic seizure," meaning that they couldn't find a reason for the seizure, which happened after Roberts had gotten off a boat at a dock near his summer home on Maine's Hupper Island.

Roberts fell on the dock and sustained scrapes. He was taken by boat to the mainland and was reportedly conscious and alert when he was transferred to an ambulance and taken to the Penobscot Bay Medical Center in Rockport, Maine.

At the medical center, Roberts got a "thorough neurological evaluation, which revealed no cause for concern," Supreme Court spokeswoman Kathy Arberg told reporters.

Roberts reportedly had had a seizure in 1993. In 2001, he told the Senate Judiciary Committee that his health was "excellent," according to the Associated Press.

WebMD spoke with Jacqueline French, MD, about Roberts' seizures. French is a professor of neurology at the University of Pennsylvania. She's not one of Roberts' doctors and hasn't seen his medical records.

What is a "benign idiopathic seizure"?

There is no such thing as a category of seizure called "benign." A seizure is a seizure. It's not a benign thing to have a seizure. I think what they're trying to get across with that word is that there is not an underlying cause that's alarming. He hasn't been discovered to have an infection or a brain tumor or anything along those lines. But other than that, there is no "benign."

The other thing is that they are being very careful to call it a seizure but in fact -- and obviously it was a seizure -- but the fact that he has had two seizures without cause -- one in 1993 and the most recent one -- actually puts him in the category of epilepsy because the only definition of the word "epilepsy" is more than one unprovoked seizure. So once you've had two unprovoked seizures, you in fact have epilepsy. And the reason that we use that term is because the likelihood of having a third once you've had two is more than 50%.

Now, when that third [seizure] would occur is very unclear, and obviously it has been a very long time since his first seizure, at least as far as we know. So it could be a very long time -- if he was going to have a third [seizure] -- before he would have a third [seizure]. But for most people that would be the point at which you would consider trying to prevent a third by giving some kind of mild treatment.

What might such treatment be -- an antiseizure medication?

Exactly.

What are the some of the side effects of those medications?

Well, we certainly try and find a medication -- and it may take a couple of tries -- to find a medication that has no side effects and is well tolerated. But for most people, taking a seizure medication doesn't impact their life in any significant way other than the need to take a pill every day. Certainly, seizure medications have side effects, but we can usually match a medication to a person so that those side effects are minimized.

Are there other treatments that would be considered, or are antiseizure medications the main thing?

At this point, really the only treatment that would be appropriate would be nothing or antiseizure medications.

Is there any reason Roberts wouldn't be able to return to the bench in October, knowing what we know now?

Absolutely not. The very important message is that even people with epilepsy or seizure disorders are capable of maintaining activity in all walks of life. I certainly know people who have seizure disorders who are physicians, attorneys, judges, and every walk of life.

The other important message is that this was a very public event -- being taken to the hospital, etc. -- the public eye is upon him. But there are many people who have seizure disorders that are walking around [and] their co-workers would have no idea that they have seizure disorders. In fact, the prevalence is very high. Some numbers that are thrown around are half a percent -- one in every 200 people -- so it's very unlikely that anybody is working in a large workplace where there isn't one person with a seizure disorder.

I think that the most important take-home message is that seizures don't prevent you from living a full and important life and that they can be effectively treated with medicine, and that they're nothing to be ashamed of. I think having one like this that's out in the open is a very important thing because there is a lot of stigma against people who have seizures, for whatever reason. This is a good example that it's nobody's fault, it's not associated with some kind of mental illness; it is just a medical disorder that can be treated.

Why might there have been such a long lag time between Roberts' seizures?

I have had patients who had one seizure remotely and then another a very long time afterwards. However, if you question them closely, a subportion of those will actually report that they've been having funny events that they did not identify as seizures.

For the average person walking around who's not a medical person, a seizure means one thing and one thing only and that is fall to the ground, foam at the mouth, shake all over, which we call a generalized tonic-clonic convulsion. And that's the only thing in their head that's a seizure. So anything else that happens that's unusual, they won't count as a seizure.

But seizures can take all different forms. They can be as small as a funny, fleeting feeling that just goes through your head that you don't know why it's there, or a funny flip-flopping in your stomach followed by 30 seconds of being a little dazed, all of those things can be seizures, and those things people usually just discount.

So did he really not have a seizure between 1993 and now? Only his doctor can get the answer to that. But again, it certainly, on the other hand, is possible that one can have two seizures that are very far apart.

That doesn't mean that the next one is going to be equally as far apart. One of the concerns about seizures is that they're unpredictable. That's what makes them so worrisome to people, is that you don't know what's going to happen next. You don't know whether it's going to be tomorrow or a week from now or a month from now or 10 years from now. That is, in fact, why many people opt for some treatment, because, obviously, it can be an emotionally traumatic event, and not knowing when the next one is going to happen is usually very anxiety provoking. So a lot of people want to make sure that that's not going to happen.

What causes seizures?

We know some things that cause seizures. People are at increased risk for seizures if they've, for example, had a brain injury that produces a scar, because the scar can cause electrical instability in the brain, or anything else that causes a scar, such as an old infection.

Certainly, brain tumors can cause seizures, but that's a less likely cause. Anything that locally interrupts the brain can cause a seizure -- a stroke, an old stroke is another potential cause. And sometimes people are born with little pieces of tissue that have migrated to the wrong part of the brain, so that the connections are not right. In every other way, they function completely normally, but those abnormal connections cause electrical disturbance. So sometimes it's something you have been born with but it may not manifest itself until much later in life.

There are genetic causes as well, but those usually show up in children, not in adulthood, so it's unlikely that that is the cause in this case.

And then there are causes that we just don't know about.

Right.

According to media reports, Roberts was conscious and alert when they were transferring him to the ambulance. Would that be normal?

It's variable how long it takes to recover, and we don't know how long it took for the ambulance to get there. A typical seizure lasts something like 90 seconds, and afterward, it may take 10 minutes to completely come to complete alertness. People slowly arouse after a seizure. After a few minutes, they may be able to respond to questions but not be completely back to normal. It may take much more time to get 100% back to normal.

Roberts spent the night in the hospital for observation. Would a patient typically go home the next day?

Absolutely. Some tests, probably, were done. Under normal circumstances, one would do a test called an electroencephalogram [EEG] to see whether there's abnormal electricity -- brain waves -- and one probably would normally do an MRI, which would just be a structural test to look for any scars or infections or tumors, and that basically would be the workup that would be required.

If people have had a number of seizures before, then hospitalization isn't even necessary. In this case, it had been such a long delay that it's worthwhile to look to make sure nothing new is going on. But if somebody had a seizure disorder that was known, hospitalization wouldn't even be necessary.

SOURCES: Jacqueline French, MD, professor of neurology, University of Pennsylvania. Associated Press.

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