NEW YORK (Reuters) - For older adults with no known history of epilepsy, such as U.S. Commerce Secretary John Bryson, a seizure may reflect underlying brain damage, including from a stroke, trauma or tumor, medical experts said on Monday.
Bryson was involved in three car accidents - including a hit-and-run - near Los Angeles over the weekend. Administration officials said these followed a seizure but did not give further details nor say whether Bryson, 68, had any underlying illnesses.
Doctors not involved in Bryson’s treatment said first seizures after age 60 most often result from damage to the brain due to a stroke, neurodegenerative disease such as Alzheimer’s or vascular dementia, trauma or tumor. For example, the first sign that Senator Edward Kennedy had brain cancer was a seizure.
First seizures typically occur in early childhood and after age 60. “Adult onset of seizures is not uncommon,” said Dr. Orrin Devinsky, director of the Comprehensive Epilepsy Center at NYU Langone Medical Center. “And anything that injures the brain, including mini-strokes and head trauma, has the potential to cause a seizure.”
A second seizure at any point, even years after a first, meets the definition of epilepsy. An estimated 2.2 million people in the United States have that brain disorder, according to a 2012 report from the Institute of Medicine.
Whatever the ultimate cause, a seizure is marked by excessive electrical activity in the brain’s neurons. Just as wild electrical bursts during a summer thunderstorm can wreak havoc with radio and television signals, so the chaotic electrical discharges in a seizing brain can knock out motor control, speech, sensory perception, consciousness, and other cortical functions.
The general public is familiar with the “grand mal” type of seizure, as often depicted in movies, which leave their victims writhing on the floor in violent, teeth-shattering convulsions. But most seizures, called complex partial seizures, occur much more quietly, leaving their sufferers conscious but confused.
Experts say it is indeed possible that Bryson suffered a complex partial seizure before his first car accident in California on Saturday evening and was still feeling its effects as he drove off to what would be a third crash five minutes later.
Bryson rear-ended a car stopped at a railway crossing in San Gabriel, Calif., and got out to speak with the three occupants, police officials said.
After returning to his Lexus he started to drive off but hit the same car, a Buick, again. Without stopping this time, he continued on for about five minutes before slamming into a Honda Accord at an intersection in nearby Rosemead. Police officers found Bryson unconscious at the wheel.
The White House did not say whether Bryson’s treatment at a local hospital turned up evidence of a stroke or other brain damage, or whether he had any known conditions that would cause a seizure.
From the official descriptions of the accidents, experts surmise that Bryson likely suffered a seizure just before he hit the first car. He was probably still in its throes when he spoke to its occupants; he was reportedly disoriented.
That matches the typical course of a seizure, whether it results from longstanding epilepsy or is a person’s first. During a complex partial seizure, the person will usually stare off into space, perhaps with the head or eyes at an unusual angle and smacking his lips repeatedly, explains neurologist and epilepsy specialist Gholam Motamedi of Georgetown University Medical Center. The seizure generally lasts a minute or two.
“You definitely see people who can walk around while having a complex partial seizure,” said Dr. Alison Pack, an epilepsy expert at Columbia University Medical Center. “They may look like they’re doing purposeful movements, but they don’t remember anything afterward.”
Once the seizure ends, which it does spontaneously, the person typically emerges “a little groggy and confused, but without remembering what happened,” said Motamedi.
Experts say it is conceivable that someone who has just suffered a seizure could operate a vehicle, though probably not well. That could explain how Bryson drove off, only to hit the Buick again and then the Accord.
“During the recovery to full consciousness, there is a transitional period of 50 to 60 minutes, but as long as 24 hours, when the person can make irrational decisions and do things a healthy person would not,” said neurologist Imad Najm, director of the epilepsy center at the Cleveland Clinic.
The most likely cause of a seizure in a case like Bryson’s is a mini-stroke. That, in turn, could result from a deformation in a blood vessel in the brain that suddenly began bleeding, or an old trauma. Head injury can also trigger a seizure, but there is no evidence that Bryson hit his skull before the first crash.
A complex partial seizure can be followed by a convulsive seizure. Bryson may have suffered such a “grand mal” seizure in the seconds before the final crash, after which he was found unconscious.
Like so much about epilepsy, how head trauma or a stroke might cause a seizure is poorly understood. One possibility, said NYU’s Devinsky, is that the brain damage causes inflammation.
Editing by Michele Gershberg and Cynthia Osterman