Medical Author: Benjamin C Wedro, MD,
FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
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, 2008 doctors announced that a tumor had been identified as the cause of the seizure. Tissue samples taken at biopsy revealed that Senator Kennedy has a malignant glioma of the parietal lobe of his brain. Senator Kennedy passed away from the malignant glioma tumor on August 25, 2009 at his home in Hyannis Port, Massachusetts at the age of 77.
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.
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 in regard epilepsy is asked, but the two terms are not synonymous. A person can have a seizure and not have a seizure disorder. Seizures are fairly common. The chance of having a seizure in your lifetime is almost 10%; and many times the cause of a seizure is never determined.
Seizures can have a variety of causes including the following:
- febrile seizures (in
children);
- withdrawal from alcohol;
- low blood sodium levels
(hyponatremia);
- low blood sugar;
- head injury (it's
not uncommon to witness a seizure after a patient has been knocked
unconscious),
- electrolyte
abnormalities,
- drug abuse,
- bleeding in the brain,
- tumors, or
- stroke.
Seizures may also signal a serious problem, and
In Senator Kennedy's case, the seizure was a presentation of a severe condition - a malignant tumor of the brain. According to news sources, biopsy results indicated that the tumor was 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. If the tests come back normal, they can return to life as they know it. Unfortunately, medical tests are performed to access the possibility of major illnesses. The seizure becomes life-altering, and sometimes, as in Senator Kennedy's case, a life-threatening event, which eventually lead to his death.
