Experts Split on Whether Chief Justice Roberts Has Epilepsy

TUESDAY, July 31 (HealthDay News) -- U.S. Supreme Court Chief Justice John Roberts walked out of a Maine hospital Tuesday morning with a clean bill of health, one day after suffering a seizure and falling on a dock near his summer home.

But doctors interviewed by HealthDay were divided on whether the seizure -- the second one the 52-year-old jurist has suffered in 14 years -- is a sign that Roberts has epilepsy, a neurological condition that could require him to take anti-seizure medication to control the disorder.

Roberts left Penobscot Bay Medical Center in Rockport shortly before noon after suffering what doctors described as an unexplained seizure near his vacation home in Port Clyde on Hupper Island. The doctors who examined him found no sign of a tumor, stroke or any other explanation for the episode. He plans to continue his summer vacation, Supreme Court spokeswoman Kathy Arberg told the Associated Press.

Roberts' first reported seizure occurred while playing golf in 1993.

In a phone call with President Bush Tuesday morning, Roberts said he was doing well. The chief justice "sounded like he was in great spirits," White House press secretary Tony Snow said, the AP reported.

On Monday, a Supreme Court statement said the chief justice was "fully recovered" from the 2 p.m. seizure and had undergone "a thorough neurological evaluation, which revealed no cause for concern." He was kept overnight as "a precaution," The New York Times reported.

Dr. Steven Pacia, chief of neurology at Lenox Hill Hospital in New York City, said that, given this was Roberts' second seizure, it's "likely" that he has epilepsy. "It's the most likely thing based on what we know from what's been released," he said.

Pacia noted that seizures can result from an inherited susceptibility that is trigged by such factors as a lack of sleep or stress. "It sounds to me he does have idiopathic generalized epilepsy syndrome, which means that he has susceptibility to seizures under certain circumstances," he said.

Dr. Laura Kalayjian, an assistant professor of neurology and co-director of the Epilepsy Center at the University of Southern California, agreed that Roberts probably has epilepsy.

"The definition of epilepsy is two unprovoked seizures," Kalayjian said.

The likelihood of someone having a second seizure after a first one is about 30 percent, Kalayjian said. "Now Roberts' risk of having another seizure is greater than 50 percent," she said.

However, Kalayjian added that it's not certain that Roberts had a seizure at all on Monday. Other reasons for this type of an event are abnormal heart rhythms or low blood sugar, she said.

Even if Roberts has epilepsy, it shouldn't affect his work, Kalayjian said. "The majority of people with epilepsy you wouldn't know they had epilepsy," she said. "About 70 percent of people with epilepsy do fine; they hold high level jobs, they drive. It's only 30 percent of people that have uncontrolled seizures that need specialized epilepsy centers to get their seizures under control."

Another expert believes it's too soon to say that Roberts has epilepsy.

"There are a lot of different causes that can be responsible for a seizure other than epilepsy, and some of those are very hard to detect with a regular MRI. They require more sophisticated tests," said Dr. Isabelle Germano, a professor of neurosurgery at the Mount Sinai School of Medicine in New York City.

Germano agreed that two seizures are, by definition, epilepsy. "But, usually in the adult population, we don't see a 14-year interval between seizures," she said. "The delayed interval might make it something else."

Also, whether the two events were seizures isn't clear, Germano said. "We don't know if this was really a seizure event as opposed to syncope (fainting)," she said.

Before considering starting anti-seizure medication, more tests are needed to try to uncover the reason for Roberts' seizure, Germano said.

Whether or not he should be taking anti-seizure medication is something Roberts' doctors will have to evaluate, Kalayjian said. "His doctors should be trying to figure out if there were any triggers that caused the seizure," she said.

Kalayjian noted that medications do provide some protection by raising the seizure threshold. "It would give him [Roberts] an extra level of protection, especially if he is going to be driving or doing other activities," she said.

But, anti-seizure medications aren't without side effects, Kalayjian said, including dizziness and sleepiness.

In addition, Kalayjian said, it's important to get eyewitness accounts of what happened on Monday. "It's also important to get the patient's account of what happened -- did they have any neurological changes prior to the event," she said.

On Monday, Roberts was taken by ambulance to Penobscot Bay Medical Center. He was "conscious and alert" when he was put in the ambulance, Tim Polky, the fire chief in the town of St. George, which includes Port Clyde, told The New York Times.

According to the Epilepsy Foundation, epilepsy is defined as chronic seizures; it's also called a seizure disorder. A seizure occurs when a brief surge of electrical activity affects part or all of the brain. For 70 percent of people with seizures and epilepsy, the cause of their condition is unknown.

Seizures can last a few seconds to a few minutes. The symptoms can vary -- from convulsions and loss of consciousness to some that are not always recognized as seizures by the person experiencing them or by health care professionals: blank staring, lip smacking, or jerking movements of arms and legs.

One percent of the U.S. population -- more than 3 million Americans -- is treated for epilepsy, most commonly with anti-seizure medications, the foundation said.

More information

For more on epilepsy, visit the Epilepsy Foundation.

SOURCES: Isabelle Germano, M.D., professor, neurosurgery, Mount Sinai School of Medicine, New York City; Laura Kalayjian, M.D., assistant professor of neurology, co-director, Epilepsy Center, University of Southern California, Los Angeles; Steven Pacia, M.D., chief of neurology, Lenox Hill Hospital, New York City; Associated Press; The New York Times

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