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Brain & Nervous System Health Center

Chief Justice John Roberts Has Seizure

10 Questions and Answers on Roberts' Seizure
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What causes seizures?

We know some things that cause seizures. People are at increased risk for seizures if they've, for example, had a brain injury that produces a scar, because the scar can cause electrical instability in the brain, or anything else that causes a scar, suchas an old infection.

Certainly, brain tumors can cause seizures, but that's a less likely cause. Anything that locally interrupts the brain can cause a seizure -- a stroke, an old stroke is another potential cause. And sometimes people are born with little pieces of tissue that have migrated to the wrong part of the brain, so that the connections are not right. In every other way, they function completely normally, but those abnormal connections cause electrical disturbance. So sometimes it's something you have been born with but it may not manifest itself until much later in life.

There are genetic causes as well, but those usually show up in children, not in adulthood, so it's unlikely that that is the cause in this case.

And then there are causes that we just don't know about.

Right.

According to media reports, Roberts was conscious and alert when they were transferring him to the ambulance. Would that be normal?

It's variable how long it takes to recover, and we don't know how long it took for the ambulance to get there. A typical seizure lasts something like 90 seconds, and afterward, it may take 10 minutes to completely come to complete alertness. People slowly arouse after a seizure. After a few minutes, they may be able to respond to questions but not be completely back to normal. It may take much more time to get 100% back to normal.

Roberts spent the night in the hospital for observation. Would a patient typically go home the next day?

Absolutely. Some tests, probably, were done. Under normal circumstances, one would do a test called an electroencephalogram [EEG] to see whether there's abnormal electricity -- brain waves -- and one probably would normally do an MRI, which would just be a structural test to look for any scars or infections or tumors, and that basically would be the workup that would be required.

If people have had a number of seizures before, then hospitalization isn't even necessary. In this case, it had been such a long delay that it's worthwhile to look to make sure nothing new is going on. But if somebody had a seizure disorder that was known, hospitalization wouldn't even be necessary.

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