Justice Roberts: What Do His Seizures Mean?

News that Chief Justice John Roberts, who at 52 is the youngest justice on the Supreme Court, had a seizure on Monday, provoked intense speculation about his health. Was this, his second seizure, a sign of epilepsy or another disorder?

The episode on Monday caused Roberts to fall on a dock while vacationing at his summer home in Maine. A similar situation occurred in 1993. This time he suffered minor scrapes and was released Tuesday from the Penobscot Medical Center in Rockport, Maine.

The White House reports that he is "doing fine," but the incident is a reminder that this widely researched, yet still unexplained phenomenon, is fairly common. About one in every 10 people will have a seizure in their lifetime.

Experts say that anyone who experiences seizures without known cause more than once in their lifetime—regardless of how many years apart—has epilepsy—a condition that is reputed to have afflicted historical figures from Napoleon to Alexander the Great.

NEWSWEEK's Jemimah Noonoo spoke with Michael Sperling, professor of neurology and the director of Jefferson Comprehensive Epilepsy Center in Philadelphia, about the latest research on seizures and their treatment. Excerpts:

NEWSWEEK: What exactly is a seizure?
Michael Sperling:
Having a seizure implies there was a temporary malfunction of the brain, a misfiring of the neurons, which are the class of cells we use to think and do things with our brain. There are two kinds of seizures. One that starts everywhere more or less in the brain is called a generalized seizure. The other type is partial or focal seizures, which start in one spot and then either remain confined to that spot or spread to other regions of the brain.

Some media reports have called it a "benign idiopathic seizure." What does that mean?
A benign seizure is brief, and that was that.  It is a transient loss of consciousness. Idiopathic means we don't know. Another term is cryptogenic, which means it has a hidden cause. Typically, when seizures develop as adults, it is partial or focal.  The end result could be falling down or shaking in both generalized or partial seizures.  Most likely, [Roberts's] seizure spread to both sides of the brain, and that is why he passed out.

What's the next step for Chief Justice Roberts?
The most important thing is to take a comprehensive medical history, to probably go back in the 1990's. An MRI scan can determine if there are any underlying structural abnormalities of the brain; an EEG test can look at the electrical activity of the brain. One of the things needing to be evaluated is to make sure that there is not a different cause, like a cardiac arrhythmia, which could cause a brief loss of blood flow to the brain. Not all seizures come primarily from the brain.

How will this affect his work on the bench?
Probably not at all.  If he is put on medication, the medications have the potential to cause cognitive problems. Will it prevent him from working? No. In fact, I have a couple of judges among my patients.

How common are seizures among men in their 50s, like Roberts?
You're more likely to develop [seizures] as a small child. Between the ages of 15 and 60 it's least likely.

How is it treated?
There are currently about eight to 10 drugs, which are called anticonvulsants, which are commonly used to prevent seizures from recurring.  Treatment is an option. One does not have to automatically be treated.  It is not so clear yet that Roberts needs to be on medication. If you have seizures every couple of months, you want to take medicine, but may not if you have it one out of every 14 years. That will be the thing he wants to decide.

Are there any new treatments on the horizon?
The newest developments in this field apply to those patients whose seizures cannot be controlled by medication. Within the past three or four years, more powerful magnets have come into common use with MRI's [magnetic resonance imaging]. These tools offer marvelous view of brain structure, improved diagnostic ability and changes in software.

This does not relate to Chief [Justice] Roberts [because it's unclear whether his seizures will need to be controlled by medication], but neuro-stimulation is basically a small computer chip that is implanted in someone's head, with a little electrode over the area of the brain that charters seizures.  The computer is constantly watching the EEG, and when it sees a seizure is about to start, has a stimulator deliver an electrical shock to that part of the brain where the seizure begins in an effort to shut down the seizure. A number of centers around the country are testing this device—my gut feeling is that it may be the future of epilepsy treatment.

How many people do seizures affect?
One out of every 10 people will have a seizure in their life, and most people who have one do not have another.  Recurring seizures without a known or provoked cause—epilepsy—affect about six out of 1,000 people.

How has the science of understanding seizures changed?
There have been many careful investigations in the last couple of decades with the careful study of humans who have epilepsy, and the use of MRI, EEG analysis and genetic testing. Secondly, there have been a lot of investigations of animal models of epilepsy, and models at the cellular and sub-cellular levels, so we have a better understanding of what causes seizures.  There are some people who have a rough idea of when a seizure is most likely to occur, but that's the rub, people usually do not know and have no warning whatsoever.  That's the biggest problem with epilepsy. There has always [been] a stigma attached to those who have epilepsy. It has gotten better, but I don't know that it has gone away.

Could this happen again?
If you've had a second seizure, the probability of having another is relatively high, 80-85 percent. Of course, the question is when.

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