(This blog was originally posted on July 12, 2011)
Dr.
Brien J. Smith, the medical director of the comprehensive epilepsy program at
Spectrum Health Butterworth Hospital in Grand Rapids, Michigan, is the new
chairman of the Epilepsy Foundation.
On
June 23, 2011, the New York Times
published an article about him in which Dr. Smith disclosed that he has epilepsy.
He described his childhood experiences having unrecognized seizures that
weren’t recognized as epilepsy until high school. Years later, now a
doctor-in-training, he had a seizure at the hospital where he worked. The
doctor said that medical and nursing staff panicked when they witnessed one of
their own have a convulsion.
Epilepsy
is a frightening and poorly understood condition. This may come as a surprise
to many people, but as demonstrated by Dr. Smith’s anecdote, even general
medical, surgical, and nursing communities need to be educated about it. Physicians
seldom diagnose epilepsy in a patient who appears confused or has lost
consciousness without the tell-tale shaking (convulsion) associated with
epilepsy. This lapse is worrisome: symptoms of Post-Traumatic-Stress Syndrome,
panic attacks, and even simple daydreams can mimic behaviors seen during the
most common type of seizure, the complex partial seizure. Even the
electroencephalogram can be “normal” if the person does not have a seizure while
the test is being done.
A
neurologist needs to question the patient, his family, and other observers to
make an accurate determination that a seizure has occurred and to make the
epilepsy diagnosis. The specialist will ask specific questions about imagined
smells or tastes (hallucinations), adult bed-wetting, and biting the lips or
tongue during sleep to elicit clues that can support the diagnosis. I provide a
comprehensive description of the neurological examination that neurologists use
to diagnose epilepsy in my recently completed, but not yet published novel, DINGS. Excerpts can be
read on my website: LanceFogan.com.
Lance Fogan, M.D. is Clinical
Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.
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