Thursday, August 09, 2007

Normal life can be done despite seizures

He can feel the sensation coming on. Twenty seconds before a thrust of unconsciousness hits him like a bolt of lightning in the brain, he begins to feel dizzy. He gets down on the ground, or pulls off to the side of the road, bracing for this uncontrollable storm.

The next thing he knows, 54-year-old Jerry Kralovansky is waking up, feeling really groggy. And all he wants to do is go home and sleep."I just know it's happening," said the Plymouth resident, who has had probably half a dozen of these seizures since 1981, when a blood vessel in his brain ruptured in a cerebral vascular accident that required surgery to remove the blood clot.

"It's like you're fainting. You get dizzy, your vision gets kind of blurry and you just know it's coming."But fortunately, he said, the "shaking all over" hasn't come for five to six years now -- a marked change from when surges used to occur every four or five months, striking him anywhere from the tennis court to the golf course to his home."Unless it's in your family or you have it yourself, you take a lot of things for granted," said Kralovansky, whose wife, Mary Jane, started Garden of Hope about three years ago to support those who suffer from neurological disorders such as epilepsy, stroke, multiple sclerosis and Parkinson's disease.

"Once you've had it, you realize how many other people have it," Jerry Kralovansky said of seizures.Seizures affect millions, with one in 10 adults experiencing at least one episode in their lifetime. U.S. Supreme Court Chief Justice John Roberts had his second seizure in 14 years Monday, joining the 1 percent of people who have second or third seizures, and joining the 50 percent of Americans with seizures who don't have a readily identifiable cause, said Michael Englert of South Bend Neurology.

Unclear conditionRoberts -- who grew up in Indiana's northwest town of Long Beach and who left the hospital Tuesday before returning to his summer home off Maine's coast -- bore no tumor, stroke or other known cause for his seizure, according to The Associated Press. His episode this week has sparked a storm of questions about seizures and their link to epilepsy.

By definition, those who've had more than one unprovoked seizure separated by time are epileptic, Englert said. A seizure is a sudden surge of electricity in the brain -- a storm that can be triggered by a stroke, brain injury, high fever or certain medications, Englert said. Other triggers include lack of sleep, irregular eating habits or hypoglycemia, said Nasar Katariwala, general neurologist with a specialty in epilepsy at The NeuroClinic in Michigan City.

Chances of having a third seizure strongly increase, doctors say."Certainly to go 14 years (without one) can speak for a very good prognosis," said South Bend's Englert, who's been in the field for 22 years. "(Roberts) may have another one, but it may be a very long time."While 70 percent of people experience a partial seizure -- which usually results from a brain injury or other secondary factors -- the other 30 percent usually inherit generalized seizures genetically, Katariwala said.

Resulting symptoms can range from something as minor as a muscle twitch and shaking in just an arm or a leg to frothing at the mouth, loss of bowel control, convulsions that last 30 to 60 seconds and loss of consciousness.MedicationThe main question now is whether Roberts should receive anti-seizure medication, but there's currently no clear answer because of the long stretch between his two episodes.

The downside to drugs is that they are required daily, can be costly over time and can cause side effects, "so it's not just as simple as taking a medicine and forgetting about it," Englert said. Kralovansky -- who was likely born with the weak blood vessel in his brain that caused his cerebral vascular accident -- has taken the anti-seizure medication Tegretol daily since 1981 and undergoes annual tests through his general practitioner. He attributes the fewer episodes in recent years to the medication, he said.

Seizures most frequently occur in the first year of life -- usually due to some congenital problem or birth injury -- or after age 60, as a result of stroke, degenerative brain diseases or repeated head trauma. When seizures are genetic, they begin during childhood or adolescence, Englert said.For those who have epilepsy or who are predisposed to having seizures, the key to helping prevent these episodes -- besides medicine -- includes getting adequate rest, not skipping meals or going too long without eating and avoiding some specific kinds of antidepressants, antibiotics or narcotics, Englert said.

Still, Roberts' work from the Supreme Court bench shouldn't be affected by the past couple of temporary short-circuiting episodes in his brain, local doctors say."If the right medication is given, the side effects are zero and the seizure is controlled completely, then the person can function very well," Katariwala said.

If Roberts were his patient, Katariwala would put the chief justice on medication, as well as perform a measure of brain activity called an EEG, conduct an MRI of the brain and examine in detail his family and personal history, in addition to studying the two seemingly spontaneous seizures. If there was any indication that both seizures were provoked, the doctor would observe the patient but not treat him, he said.


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