Sunday, April 15, 2007

Seizures are challenging

What is the normal treatment for a single seizure? What would be the risk of a person having a second seizure? What do doctors normally suggest for a very healthy and active senior? Nobody seems to have answers for these questions.

Few things are more challenging for physicians than deciding how to treat a single seizure, says Dr. Kevin Sullivan, a Medford neurologist.

A seizure occurs when abnormal nerve activity in the brain changes the way the body functions. Some people lose consciousness; others may twitch uncontrollably or become aware of unusual smells, such as burning insulation.

"It all depends on which nerve cells are involved," Sullivan says.

A seizure typically lasts just a few minutes, and anybody can have one. A sharp blow to the head, for example, could cause a person in otherwise good health to have a seizure.

Many of the symptoms associated with a seizure also can be caused by other conditions, so neurologists first have to determine whether a patient's symptoms are the result of a seizure or something else. A stroke, for example, could cause a patient to lose consciousness or muscle control, and low blood sugar associated with diabetes also could cause a patient to lose consciousness.

"You have to look at the patient's history," Sullivan says.

Physicians also use a number of diagnostic tests to determine whether symptoms are caused by abnormal brain activity or some other condition.

But even with all the tests that are available, physicians can't determine the cause of about 50 percent of single seizures.

To complicate the picture even more, studies indicate that about half of the people who have had a single seizure will never have another. Physicians and patients have to decide whether the chances of having another seizure justify taking drugs for the remainder of the patient's life.

"Some people say they don't want to ever worry about (a seizure happening) again," Sullivan says. Many of them choose to take drugs and learn to live with the side effects (such as drowsiness, constipation or headache) rather than risk the chance of having another seizure.

Someone who is young and otherwise healthy might choose a "wait and see" attitude rather than face a long lifetime of drug-related side effects to treat something that might never happen again, Sullivan says.

"We hold off (prescribing drugs)," Sullivan says, "and see how they do.
"The bottom line is, it's not an easy call."


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