Thursday, February 25, 2021

Blog #127: INVOLUNTARY STERILIZATION FOR EPILEPTIC PEOPLE




I write my monthly blogs on LanceFogan.com, 127 to date, in order to raise epilepsy awareness.  One percent of all Americans and one percent of world citizens live with epilepsy and they include all levels of intellectual and physical abilities.

In the early 19th and 20th centuries epilepsy was lumped in with individuals considered to have mental retardation, physical handicaps, and genetic disorders. A frightening fact is that these individuals, including those with epilepsy, could be sterilized against their consent and without their knowledge in more than 30 American states to “stop spreading bad genes.” This was achieved by state-ordered-law. The U.S. Supreme Court allowed this injustice to continue beginning in the 1920’s. These state laws finally changed in the 1970’s.

Virginia’s forced sterilization law in 1924 authorized involuntary sterilization to rid society of "idiocy, imbecility, feeble-mindedness or epilepsy." 1 Carrie Buck, age 20, along with her mother, Emma, was an inmate in the Virginia Colony for the Epileptic and Feebleminded. Dr. Albert Priddy, the institution’s superintendent, authorized Carrie’s sterilization without her personal consent. She was the first person to be so subjected to “end her bad gene-line. The Virginia Times Daily, May 2, 1927, wrote that Carrie Buck had the mental age of 9 years. Others wrote that she was “dull but not stupid.”

Adam Cohen's recent book about the Buck case, Imbeciles, takes its name from the terms eugenicists used to categorize the "feebleminded."2 In it, he revisits the Buck v. Bell ruling and explores the connection between the American eugenics’ movement of “erasing bad genes” and the rise of the Nazi party in Germany. Cohen notes that the instinct to "demonize" people who are different is still prevalent in the U.S., particularly in the debate over immigration. This poor young woman, Carrie Buck, was said to really have nothing wrong with her physically or mentally. She had been a victim of a terrible sexual assault. After a brief hearing she was declared feebleminded and was sent off to the Virginia Colony for the Epileptic and Feebleminded. Subsequently she was surgically sterilized.  

The American Eugenics Society promoted ideas of racial betterment and genetic education through public lectures, conferences, publications and exhibits at county and state fairs — like this chart labeled "The Triangle of Life" from the Kansas Free Fair in 1926.

 

Epilepsy does not correlate with mental retardation although these conditions may coexist. A seizure is but a symptom of a brain dysfunction, it is not linked to intelligence or mental status.

  1. The United States Once Sterilized Tens of Thousands –Here’s How the Supreme Court Allowed It.  Cato Institute COMMENTARY JANUARY 27, 2016. By Trevor Burrus
  2. Cohen, Adam. Imbeciles. Published March 1, 2016

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is a medical mystery and is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

 

 

Monday, January 25, 2021

Blog # 126: MORTALITY IN OLDER ADULTS WITH EPILEPSY

As my 15th monthly blog reviewed in December 2011 available on my website: LanceFogan.com, it’s surprising to many that the onset of epilepsy is currently most common in the over sixty-five age group versus the onset in children. While the incidence of epilepsy decreases in children over time it increases in the elderly population, in grandparents, whose brains are more apt to be afflicted with trauma and stroke scars, tumors, and other ailments (1, 2). Five to fifteen percent of patients will experience a seizure within two years after a stroke (3). Note that other ailments associated with aging, such as Alzheimer’s Disease and Parkinson’s Disease are not commonly associated with epilepsy.

Increased life expectancy has led to this larger proportion of elderly people in developed countries. Recent studies show that newly diagnosed epilepsy in older adults is associated with high 5-year mortality among Medicare beneficiaries. One study found a 5-year mortality rate of 62.8% in Medicare beneficiaries age 65 and older with new-onset epilepsy. This is more than double the 5-year mortality rate in the overall general Medicare population without epilepsy from which the sample was drawn. Death in older adults with epilepsy is common (4). Associated ailments that increased the hazard of death includes cancers, chronic heart disease, strokes, diabetes, chronic obstructive pulmonary disease (COPD) from years of smoking, osteoporosis associated with hip and other fractures, unhealthy diet, dementia, etc.

Researchers identified a total of 33,615,037 people, ages 65 and above, who had been enrolled in Medicare for at least 2 years on January 1, 2009. Of these, 99,990 (0.3%) were diagnosed with epilepsy in 2009. Nearly one third (29.2%) of the 33 million qualifying beneficiaries died during the 5-year observation period. The death rate was substantially higher in the incident epilepsy subpopulation: 62.8% (n = 62,838) died within 5 years. Future studies will use Medicare claims linked to electronic medical records to understand the interplay between race, sex, poverty, and comorbid disease on mortality and to determine the comparative effectiveness of newer epilepsy treatments in elderly patients with epilepsy (5).

Our senior epilepsy population must safeguard their health by taking current COVID-19 precautions, getting vaccinated, stop smoking and take medications as directed.

 

  1. Sillanpaa, et al. Epilepsy Res. 2006; Oct: 71 (2-3): 206-15.
  2. Hauser, W.A., et al. Mayo Clinic Proceedings 1996; 71: 576-586.
  3. Herman, S. Neurology, 2011: 77: 1776-1777.
  4. Lichtman JH, Jones SB, Leifheit-Limson EC, et.al.. 30-Day mortality and readmission after hemorrhagic stroke among Medicare beneficiaries in Joint Commission Primary Stroke Center-certified and noncertified hospitals. Stroke 2011; 42:3387–3391.
  5.  Leah J. BlankEmily K. ActonAllison W. Willis. Predictors of Mortality in Older Adults with Epilepsy Neurology October 21, 2020

 

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

 

Saturday, December 26, 2020

Blog # 125: “THREATENED” POLICE SHOOT AND PARALYZE MAN. WOULD AN “EPILEPSY ID BRACELET/NECKLACE” HAVE HELPED?


 

Wearing an “Epilepsy ID” bracelet/necklace may have prevented this tragedy on a conscious but uncommunicative person. Almost ten million dollars were awarded to this highly skilled computer worker vacationing with his teen-aged son.

 

“The man was acting “strangely and seemed to be suffering from some sort of mental psychosis,” the son said on his 911 call to police. Dispatched officers were alerted to a “possible serious mental health disorder needing treatment.” The dispatcher added information given by the son that “the man had a brain condition that can cause him to become dazed and unaware of his surroundings.”

 

The injured man later reported that he had no recollection of the sheriff deputy’s lit flashlight in the dark vacation cabin and has no memory of picking up the large fork from the counter as he paced. He did not remember waking in a hospital being told he had been shot and will never walk again. A court awarded this large sum for the Sheriff Department’s excessive force, negligence, and other alleged violations. The Sheriff claimed the man was distraught and he was shot after attempting to stab a deputy with a sharp instrument. The victim’s attorney claimed the deputy was a member of a department that was poorly trained in handling calls involving mentally ill people,

 

After being shot the victim was charged with assault with a deadly weapon and child endangerment. The victim ended up pleading guilty to a less serious charge of brandishing a weapon, a fork, as part of a plea deal.

 

These situations, i.e., situations of confused behavior and temporarily being out of touch with their surroundings is classical for epilepsy manifested by complex partial seizures, the most prevalent type of epilepsy. Most of these patients describe their transient confusion as an aura which then develops into a full-blown convulsion. But many such seizures do not progress into a convulsion; rather the confused state continues for minutes and sometimes even an hour or more where the person walks around, handles items of daily use and even mumbles speech without recollecting any of these activities when the temporary mental confusion ceases. Most of the public is not familiar with the one percent of the population afflicted by epilepsy and its different forms. Law enforcement, however, needs better training to recognize and understand the transient confusion states which could include epilepsy, illicit drug reactions or psychotic disorders.

 

I advise all people with epilepsy in all its forms to obtain and wear ID bracelets/necklaces that may help prevent a tragedy and even save your life.

 

 
 
Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.