In a recent interview with Glamour magazine, Brooke Shields revealed that she had a full-blown seizure. She said she was “frothing at the mouth, totally blue, trying to swallow my tongue.” This is scary for the person having the seizure and can be jarring for anyone witnessing the event, as it may have been for her friend Bradley Cooper, who helped her through the episode.
Her interview helped to demystify and challenge many of the negative thoughts about people with seizures. For centuries, seizures and epilepsy have been stigmatized and terribly misunderstood, to the point that the international flower for epilepsy is the lavender, which symbolizes isolation and loneliness, feelings commonly experienced by people with epilepsy. Her interview, published on November 1, could not have come at a better time—the start of Epilepsy Awareness Month.
What Happens After A Seizure
As a neurologist and epileptologist, I see people who have just experienced a first seizure on a near-daily basis. If you ever witness someone having a seizure, you should remain calm, lay the person on their side and do not put anything in their mouth. Someone should dial 911 so the patient can be transferred to the nearest emergency room. Emergency medical technicians will make sure the person is breathing okay, provide them with oxygen and, if the person should have another seizure, treat with medication to stop it.
In the emergency room, we will work to find out why the seizure occurred. We examine the patient, check blood sugar and obtain a CAT scan to make sure there is no bleeding in the brain. We evaluate for infections, illicit drug use and metabolic abnormalities. Shields shared that she had a low sodium level because she was drinking too much water.
We get an electroencephalogram to record the brainwaves. To perform an EEG, a trained technologist applies sensors, known as electrodes, to the scalp, and they record the brainwaves and display them on a screen to be reviewed by an electroencephalographer like myself. The EEG can provide useful information, even if the patient is not actively having a seizure.
Shields’ experience—she said she couldn’t get any words out—is no surprise. “I thought to myself, This is what death must be like,” she recalled. That is a common feeling after a seizure. The seizure itself can be seen as a short circuit causing overactivity in the brain. For example, if the part of the brain that controls the right arm is having a seizure, then the person would have involuntary movements of the right arm. If the entire brain is experiencing that short circuit, you might see the entire body start shaking. That’s what we call a grand mal or generalized tonic-clonic seizure. Once the overactivity is over, the brain waves slow down and are also attenuated, which can make the person tired, sleepy and confused.
An MRI—another picture of the brain—will provide more detail about structural abnormalities that may predispose a person to having a seizure. It will be helpful to have someone who can provide a full history to medical providers including birth history, developmental milestones, childhood illnesses like meningitis, prior traumatic brain injuries, strokes or brain tumors, all of which can predispose someone to having a seizure.
Treatment
Using the history and test results, doctors will decide whether the person needs to start medication. If the seizure occurred because of a metabolic abnormality, then it is typically not necessary to start anti-seizure medication. If the person has another seizure and is subsequently diagnosed with epilepsy, then they will need to go on anti-seizure medication. There are also driving restrictions that vary state by state.
If placed on medication, it is important to take it as prescribed and follow precautions like avoiding triggers such as alcohol. People with epilepsy can have sudden unexplained death from epilepsy. Every year about 3,000 people in the U.S. die from SUDEP, including the fastest woman ever recorded, Florence Griffith Joyner. Families should be aware of this risk and should take all necessary precautions, including vigilance with regard to taking medication.
There are many patients for whom anti-seizure medications do not work, and they may be candidates for epilepsy surgery. They would go through testing to determine which surgery would work best for them. Such a person should be followed by a neurologist—preferably one who specializes in epilepsy like myself.
While Shields may have had her first and hopefully her last seizure, there are over 70 million people worldwide who live with epilepsy. We must take steps to make sure everyone in the U.S. suffering from epilepsy—including those from underserved communities—can live free of stigma and have access to specialists so they can avoid bad outcomes like SUDEP.
Hopefully, rather than representing isolation and loneliness, Epilepsy Awareness Month and lavender will come to highlight the royalty, serenity and grace that people with this disease possess.
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