June 12, 2012 -- Now that Secretary of Commerce John Bryson has taken medical leave after a seizure apparently caused him to hit two cars in California, medical experts are scratching their heads about how a seizure could have caused the chain of events that led to the accidents, Bryson's hospitalization and his eventual leave of absence.
"There are several different types of seizures," Dr. Robert Fisher, professor of neurology and the director of the Stanford Epilepsy Center in California, said. "The one called complex partial allows a person to operate in a dream-like state over a period of seconds to minutes. She or he could operate a car, but judgment, reflexes and thinking would be impaired for several minutes.
"If [the accident] was due to a seizure, it is possible either for it to have been a cluster of a few seizures, or one seizure with a long aftermath of confusion, called 'postictal.'"
Bryson was found unconscious at his car steering wheel Saturday and cited by police for leaving the scene of an accident after he rear-ended a Buick that had stopped and was waiting for a train to pass.
After the initial accident, Bryson got out of his car, spoke to the three males in the Buick, "then left the scene, hitting the same car as he left the scene," according to police. Five minutes later Bryson allegedly hit a second vehicle containing a man and woman. He was not charged and passed a blood-alcohol test Saturday night.
A statement from the Commerce Department released early Monday suggested that Bryson had some sort of seizure. Such a claim raises many questions about what exactly happened to the secretary in Los Angeles on Saturday night, and whether or not he was in the right state of mind to make the decision to continue driving.
Seizures are a neurological disorder that cause a temporary disturbance of behavior or consciousness. They affect the non-dominant side of the brain -- the right side in most people. During a seizure, experts say, the sufferer might be able to speak full sentences.
Dr. Fisher said that if a person is driving when he or she has an epileptic seizure, it can cause a driver to crash, and possibly drive off in a confused state. It's entirely possible that the person having the seizure might have little to no recollection of the incident, he said.
Dr. Richard Kim, Director of the Hoag Epilepsy Center in Newport Beach, Calif., is skeptical that the chain of events involving Bryson's accidents where caused by one or more seizures.
Kim also says that Bryson could have had a complex partial seizure. In such cases, he said, the person having the seizure appears to be staring or fumbling, and loses awareness of his or her surroundings. Kim says that he has seen this happen to people while driving, and they typically lose control of their vehicle.
"After the seizure, he could have recovered quickly enough to walk out of the car and speak coherently," Kim said. "However, at that time he would have known that he had had a seizure, and would not -- or should not -- have resumed driving. It is possible that he had a second seizure again while driving, and that caused the second accident. It would have been highly irresponsible for him to resume driving, however."
Kim adds that if the complex partial seizure had been continuing, Bryson would not have been able to get out of the car and speak to the three men in the first car he struck, so it is impossible that he was having a seizure the entire time.
As Dr. Fisher pointed out, a possible explanation for Bryson's behavior Saturday night is what is called a "postictal state," where the sufferer continues to have a disturbance after the seizure stops. Prolonged seizures -- called status epilepticus -- can require heavy medication in order to be halted.
Dr. Gregory L. Barkley, medical director at the Comprehensive Epilepsy Program at Detroit's Henry Ford Hospital, said he believes Bryson's behavior might have been the result of a seizure.
"It is quite possible for someone to behave in a semi-automatic fashion during and after a complex partial seizure," he says. "The scenario of more than one minor accidents during a seizure and the postictal phase is rare, but not unheard of."
Barkley said that in such an instance, a full medical work up is necessary, and that a review of precipitating factors and medication adjustment would be needed.
Although Bryson's medical history hasn't been made public, it is widely believed that people who have frequent seizures, or any kind of lapse of consciousness disorder, should not be behind the wheel of a car. In California, as in many states, sufferers must be seizure-free up to six months before they can drive again.