Meet the seizure doc

LISA ALLEN-AGOSTINI

DR WENDELL BOBB was 11 when he saw his first epileptic seizure. He was in church, when suddenly he heard “this sound [he’d] never heard before”. In a Newsday interview on November 22 in Port of Spain, Bobb demonstrated, giving a strangled, high-pitched moan.

When he was a child, he thought the man was dying. The man was only having an epileptic seizure.

Now Bobb, 39, knows that “the sound was an epileptic cry which results because of the tonic seizure: the diaphragm stiffens and forces air over the vocal cords, producing that sound.”

The Trinidadian physician is chief of clinical neurophysiology, a specialisation that studies seizures, at the Washington DC VA Medical Center, and assistant professor of neurology at George Washington University. He is also certified as a sleep specialist.

Bobb was the keynote speaker of the Seizure Conference staged by the Seizure Awareness Foundation of TT (SAFTT) on November 17 at the Central Bank Auditorium.

An alummus of St George’s College, Barataria, Bobb and his parents, Torrance and Elsa, moved to the Cayman Islands 21 years ago. He was soon off to the US for college. He took a BSc in chemistry at the University of Florida before earning his MD at Florida State University, following that with specialist residencies and fellowships in internal medicine, neurology, clinical neurophysiology and sleep medicine.

He said he found the brain “alluring and almost enigmatic, like a puzzle.”

The brain is an organ in which a physical problem might cause a behavioural manifestation, unlike the heart, say, or the pancreas. It is only partly understood by medical science.

“We know a lot, but there’s so much we do not know. Consciousness, for instance. There are some things we can’t define and don’t truly understand,” he said.

His scientific study of the brain has not impeded his faith in a higher power. “I think if anything it has buttressed my belief system, because when you see how intricate it is, and how many millions of moving parts there are, it’s so much more difficult to believe that this is all happenstance rather than the work of a great designer, who I call God. It amazes me.”

One thing that medical science does understand is how seizures occur. Neurons and neurotransmitters in the brain are governed by accelerators and inhibitors – like the gas and brakes of a car, Bobb said. When these fail, there’s abnormal activity in the brain and the seizure occurs. Epilepsy can be treatable – but that first requires diagnosis.

Mistaking seizures for "demon possession" is common in TT, anecdotal evidence suggests. Bobb said a spoken-word performer at the conference even included it in her piece.

Bobb refuted that with a biblical quote. “The Bible actually does address it: Matthew 4:24 talks about seizures as separate from demon possession. So there should be no reason to conflate these two,” he said.

“It’s not only hurtful, but it’s harmful because [affected people may be] missing out on necessary treatment. Since there is an increased risk of death in people who have epilepsy, it’s important to get the diagnosis right.”

The risk of death in people with epilepsy is higher, even adjusting for drowning, cardiac events and accidents, Bobb said, citing a condition known as Sudden Unexpected Death in Epilepsy (SUDEP). The risk of death among people with epilepsy is three times higher than among the general population, Bobb said. However, he stressed that the risk decreases with treatment and the occurrence of fewer seizures.

His presentation at the conference covered brain anatomy, the basic mechanism of the seizure, different types of seizures, and treatment.

He paid special emphasis to women and seizures and said it is important women with epilepsy plan for pregnancy.

“One thing I underscored is that although the rate of teratogenic [causing foetal abnormalities] effects is slightly higher with the antiepileptic drugs – in the normal population it’s one to three per cent; with many of the antiepileptic drugs, especially the newer ones, it could be four or five per cent – the risk of having a seizure in pregnancy far outweighs the risk of having congenital malformations.

“If someone has a seizure during pregnancy, that can impede the oxygen flow to the foetus. It can also cause smaller birth weights. There’s up to ten times higher risk of death of the foetus or the mother. So it’s important for women to discuss with their physicians if they plan to conceive.”

How common is epilepsy in TT?

“There are no definitive statistics,” said Nichole Vanderpool, SAFTT president. “However, local neurologists estimate that 40,000 could be living with seizures in TT.”

The Seizure Conference, free to the public, had 300 people present. Local neurologists also spoke at the conference.

Dr Bobb’s top three things to tell someone who is recently diagnosed:

1. Once their condition is well controlled, they can live a relatively normal life. Most people with epilepsy have a normal IQ and can hold jobs.

2. Take your medications.

3. Find a support group if possible.

Sidebar:

If you see someone having a seizure:

“Certainly, don’t put anything in their mouth,” Bobb said. “It’s a myth that you can swallow your tongue.”

“If someone is having a generalised tonic-clonic seizure, where they’re shaking all over, it’s important that you don’t try to stop them from shaking, because a lot of the time that in itself can cause injury.

“Don’t try to give CPR. Towards the end of the seizure it appears that people become apneic – they stop breathing for a while – and people may think they have died and they try to administer CPR. Leave them alone.

What should you do?

“Lower them to the ground.

“Turn them on the side. That helps to open the airway.

“Remove any glasses.

“Remove anything that’s tight around the neck.

“Try to put a jacket under the head, so that if the person is hitting his head it will hit something soft.”

“If it’s someone’s very first seizure they certainly need to call the ambulance to try to get that evaluated,” Bobb said. But if the person is diagnosed and in treatment, just leave them alone. “Stay with them, make sure they’re comfortable. They’re likely to be confused and tired for a few minutes.”

Bobb added, however, “If the seizure seems to be occurring for five minutes or more, that’s when someone needs to call an ambulance or get medical help. Otherwise, for someone who has epilepsy, which is defined as two or more unprovoked seizures, and [they are] taking medication, they don’t need to go to the hospital every time.”