(June 30, 2008 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a medical condition.
On a recent trip to Boston, we caught up with Dr. Steven Schachter, MD, a Professor of Neurology at Harvard Medical School, and the Director of Neurology Research at Beth Israel Deaconess Medical Center. Dr. Schachter has authored or edited 16 books on epilepsy, including the popular "Brainstorms" series, and is also the Editor-in-Chief of Epilepsy.com and the medical journal, "Epilepsy & Behavior."
If I just had my first seizure…
If I had a seizure, when I cam out of it I would want to know what happened. I would ask somebody who may have witnessed what had just took place. Certainly if a person has a convulsive type of seizure, which doctors call a Tonic-Clonic Seizure, and it’s my first seizure, I would view it as an emergency and that the individual seek medical attention right away. But sometimes seizures are not as involved as a convulsion. In fact they can be very mild and almost inappearent. I would probably want to see my primary care physician and discuss these symptoms. Symptoms such as a funny feeling in the stomach, or a change in the way my vision works, or shaking of an arm or a leg. Something that, if I did not have previous experience with epilepsy, know could be a seizure. On the other hand there are types of seizures that are unmistakable, such as the convulsions. As I said if it is a person’s first one they should probably go to an emergency room and be checked out. There you would see an emergency room physician, and they are quite accustomed to seeing people that have just had their first convulsive type of seizure. Whether a person sees the emergency room doctor, or the primary care physician, there are certain kinds of questions that you would expect to be asked. Such as “what happened leading up to it?”, “what do you remember?”, “how did you feel afterwards?”, “was there any evidence of injury?”, and “has anything like this happened before?”. Sometimes before a person’s first convulsion there might be a funny feeling that they would have. When asked “have you ever had something like this before?”, they might say; “well I’ve never had a convulsion before, but that strange feeling of déjà vu, or stomach upset that came just before the convulsion, you know I used to get that all the time.” That’s a clue to the doctor that the individual may have been having small seizures in the past. Also you would want to be asked questions that relate to problems that can occur in the brain. Have you been having headaches recently? Fevers? Did you ever have a bad head injury? Stroke if it is an older individual. A history of encephalitis? Anything that can affect brain function, might be related to having a seizure. Then because not everyone who has a seizure has epilepsy, in fact only one in ten people that has a single seizure will go on to have more seizures, which is the way we typically define epilepsy. The doctor should enquire about other problems that can affect brain function in a way that could possibly trigger a seizure, such as verylow blood sugar, very low levels of sodium salt in the blood, or fainting and being kept standing by somebody else. There are conditions that affect the brain in a way that can trigger a seizure that doesn’t mean the person has epilepsy, or that they would need treatment with drugs to prevent seizures. That’s why after a first seizure it’s a good idea to see an internist who can explore these other areas. If they determine that the cause was epilepsy they may choose to start treatment of refer you a neurologist for further evaluation.
In Summary: If I just had my first seizure…
If I had my first seizure I would see a doctor. If my first seizure was a convulsion I would probably go to the emergency room. If not I would go see my internist pretty quickly, trying to avoid being my own doctor I would want to be treated just like any other patient by my physician. Undergo the necessary tests. If my doctor felt I was at significant risk for more seizures, to be put on a medication and follow my doctor’s directions.