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【社会人文】美国高院***官有癫痫? 能胜任主持吗
Health Blog Q&A: Epilepsy and the Chief Justice
Posted by Jacob Goldstein
Does Chief Justice John Roberts have epilepsy? And if so, what does that mean for him and the nation? Those were the questions that came to mind when we learned that Roberts suffered a seizure yesterday, and that he’d had another one in 1993.
Andrew Cole, director of the epilepsy service at Massachusetts General Hospital, answered our questions in a phone interview this morning; here are the highlights of the conversation.
Q: Roberts’s doctors said he had a “benign idiopathic seizure.” What does that mean?
A: A seizure is an episode of abnormal electrical activity in the brain. The patient might fall down, become stiff, have jerking movements in the arms and legs, maybe have some excessive salivation, turn a little blue. It typically lasts 30 to 60 seconds and afterwards the patient might be drowsy or asleep for a few minutes and then confused afterwards.
They probably called it benign to let people know it wasn’t caused by something like a tumor or a stroke or some horrible neurological disease. My guess is that in the absence of finding a clear explanation they chose to use the word “idiopathic,” but the word may not have been used in its strictest sense for our field. Classically, we call seizures idiopathic if we think a patient has a genetic trait that predisposes them to have seizures. We call them cryptogenic when we can’t identify the cause.
Q: Does the Chief Justice have epilepsy?
A: The classical definition of epilepsy is a patient who has recurrent, unprovoked seizures. Here someone’s had two events. I would want to know the circumstances around the first event, and around the second: Was he exhausted, was he particularly stressed, did he have the flu? Was he taking some kind of medication that predisposed him to have a seizure?
Any one of us can have a seizure if you push us hard enough. Most people never meet that threshold. Some people cross that threshold once in their life. Some people cross that threshold every day. You would imagine that in someone like this who has had two events , his threshold may be a little lower than the average member of the population.
Conventional wisdom is 8-10% of people will have a seizure some time during their life. One percent are formally diagnosed with epilepsy. Here you have two events. It’s a gray area. Are we going to call this epilepsy or not? He’s definitely joined the 10% club. Whether he’s joined the 1% club is a matter of debate.
Q: How do you deal with this sort of gray area?
A: If an exam, an MRI and an EEG are all normal we tell patients who have had a single seizure they have a 20% to 40% risk of recurrence in the next five years. We don’t typically recommend that they go on treatment.
If it’s a second event, the logic we apply is a little bit different, because then the importance of the tests becomes somewhat lower. The proof is in the pudding – they’ve demonstrated that they’re at risk for recurrence. But in a case like this where the gap is so long between the two events and I’m so in the dark about the events, I don’t want to imply that Roberts has to go on treatment. It’s a judgment that has to be made with more knowledge of the details of the situation.
Q: What would treatment comprise?
A: Treatment could be any of several anti-seizure medications. Many of the drugs are relatively benign and have little or nothing in the way of cognitive side effects. But at the margin, when there’s a particular premium on cognitive functioning, that’s one of the things that we think about. It’s important to keep in mind that patients go on and live normal lives in spite of an event like this. In some ways it’s a chronic illness like asthma or diabetes. It shouldn’t result in a major modification of career or lifestyle in this situation. [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-03-12 05:12
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