When Chief Justice John Roberts experienced the second seizure of his life on Monday, he may have become, in medical terms, an epileptic. Doctors classify anyone who has experienced two or more unexplained seizures as having epilepsy, a disorder in which the electrical activity of the brain is interrupted, similar to a surge on an electrical line, for brief periods of time. In some, but not all cases, this interruption can result in loss of consciousness or uncontrolled muscle spasms. Seizures can also be caused by more obvious events, such as a brain injury, fever, low blood sugar or lack of oxygen.
According to a spokesperson for the Penobscot Bay Medical Center in Maine, where the Chief Justice was taken after his seizure caused him to fall onto a dock at his summer home, Roberts was fully recovered and did not seem to show any lasting effects from the brain episode. His seizure, as well as an earlier episode that occurred 14 years ago, were described as being "benign idiopathic," meaning that their cause is unknown.
The diagnosis of epilepsy, say experts, may not necessarily mean that Roberts will have to take anti-seizure medication, which can control the electrical activity of the brain, or have to be concerned that future events will impair his ability to function on the Supreme Court. "Epilepsy diagnosis is a meaningless term in this case," says Dr. Frank Gilliam, director of the epilepsy center at Columbia University Medical Center, who is not involved in the medical care of Justice Roberts. He notes that 1% of the U.S. population is diagnosed with epilepsy, and one-third of these cases are relatively benign and do not require treatment. "It's a wastebasket term for anyone who has had two or more unprovoked seizures."
Understanding the circumstances under which the two seizures occurred will help doctors to better determine whether or not Roberts will need medication, but doctors say that in 50% of epilepsy cases, the cause remains a mystery. Roberts had been traveling extensively prior to arriving in Maine for vacation, but whether or not jet lag or fatigue played a role in triggering his seizure isn't clear.
In deciding whether or not Roberts needs medication to control future episodes, his doctors will also consider the lengthy gap between his two events. "What's unusual in this case is the long delay between the first seizure and the second," says Dr. Jacqueline French, a neurologist at University of Pennsylvania and co-chair of the American Academy of Neurology's guidelines committee, which helps doctors decide when and how to treat seizures. "Typically, if two seizures have occurred close together, there is an up to 80% likelihood that there will be a third, and an almost 100% likelihood that medication will be started." In Roberts' case, a careful look at the EEG, a read-out of his brain wave activity, could help; any abnormalities in the EEG increase the likelihood of another seizure, says French, and would argue for starting drug treatment. There are more than 20 anti-seizure medications from which Roberts and his physicians can now chose; some work to corral the hyperactivity in one area of the brain, while others prevent the electrical anomalies from occurring to begin with. All have to be taken daily, but have relatively mild side effects.