Two episodes in which the Republican senator remained motionless and did not answer some questions from the press could be symptoms of a serious illness, according to neurologists who did not treat him..
A four-line letter, signed by Congressional physician and released Thursday by Senator Mitch McConnell, R-Kentucky, suggests that his recent bouts of inability to speak were due to “accidental dizziness” possibly brought on by his recovery from an illness. concussion last winter or “dehydration”.
But seven neurologists, based on what they called an unusually revealing video of McConnell immobile in public on two recent occasions, said in interviews Thursday and Friday that the live footage likely points to more serious problems. with health issues faced by the Republican veteran leader. .
Some neuroscientists, warning that they would not be able to diagnose the Senate minority leader from a distance, said the letter and other comments from McConnell’s office did not appear to explain why he abruptly stopped speaking at press conferences in late July and again on Wednesday. .
“If I gave this tape to a medical student and that was their explanation, I would have failed it,” said Dr. Orrin Devinsky, professor of neurology at NYU Grossman School of Medicine, referring to a report provided by Congress attending the event. doctor on Thursday. “Medically, these episodes should be taken seriously.”
Neurologists said these episodes require close medical attention and may lead to treatment to prevent a relapse. Although several theories have been proposed, including mini-strokes, doctors have said that these episodes are more consistent with focal seizures, which are electrical discharges in an area of the brain.
The senator’s aides did not disclose what follow-up care McConnell might receive. Doug Andres, the senator’s spokesman, said Friday he had nothing to add other than a letter from Congressional physician Dr. Brian P. Monahan, who did not immediately respond to requests for comment.
More information about the 81-year-old McConnell’s medical history, including whether he had such episodes off-screen, would also help rule out other possible explanations for the episodes, neurologists say.
Whether they’re caused by seizures, mini-strokes or something else, episodes like McConnell’s don’t stop most patients from working or socializing, doctors say.
“Seizures are stigmatizing in our society, which is unfortunate because they are very brief electrical interruptions in behavior,” said Dr. Jeffrey Seiver, professor of neuroscience at UCLA. “Between these rare episodes, which are usually well controlled with medication, people function perfectly normally.”
However, experts said that seizures carry an increased risk of cognitive or behavioral problems and may affect older patients differently.
Rarely does the public get such a complete picture of a public figure’s serious medical event as it has done twice in recent weeks with McConnell. For neuroscientists, videos like those showing McConnell from the moment he seemed to lose the ability to speak are more than just a curiosity.
They can help establish the basis of a diagnosis, just as home videos of patients sometimes do in standard neurological practice.
“They’re very helpful because you’re not subject to the vagueness of someone’s description and you can pick up a hint of it, which is especially important with seizures,” said Dr. Anthony Kim, professor of neurology at California State University. California, San Francisco.
Small details such as the direction of people’s gazes during such an episode could provide a potential clue to the cause, Kim says.
Noting McConnell’s symptoms – his abrupt cessation of speech, his staring into the distance, his apparent recovery in about 30 seconds – Kim said “the possibility at the top of my list would be a seizure.”
The fact that McConnell’s second episode was so similar to the first was even more suggestive of a seizure, neurologists said.
Mini-strokes resulting from a blood clot that reduces blood flow to the brain can also cause short periods of slurred speech. But they rarely cause the same set of symptoms every time they reoccur because blood clots are unlikely to accidentally land in the same part of the brain twice.
On the other hand, focal seizures are often caused by malfunctions in a particular part of the brain, creating what doctors call stereotyped symptoms. They are known to stop patients, as if disconnecting them from the environment.
Patients can often reflexively answer questions during such an episode, as McConnell did on Wednesday, saying “yes” when asked if he heard a reporter’s question, even if they appear to be unable to express themselves or relate to their surroundings.
In March, McConnell suffered a concussion, which became a risk factor for seizures. Seizures can be caused by bleeding into the brain or a scar from a traumatic brain injury. Previous strokes or other types of brain damage can also cause seizures in older people, who have seizures almost as often as children.
Some seizures are triggered by factors such as abnormal blood sugar levels. But if someone has two seizures that can’t be explained that way, neuroscientists say that’s usually enough to diagnose epilepsy, a common neurological disorder that affects more than 3 million Americans and can occur at any age. They usually prescribe anticonvulsants.
“You definitely want to cure two seizures,” said Dr. Sami Hella, director of neurology at the Pennsylvania-Presbyterian Medical Center. “You don’t want this to happen, they are bad for you.”
Many patients function perfectly normally and show stable brain activity between attacks, allowing them to remain active and work even if they are forced to give up activities such as driving.
But because of them, patients miss certain periods of time during attacks. Attacking at the wrong time, such as when crossing the street, can be dangerous. And focal seizures affecting one area of the brain can become generalized, causing episodes characterized by twitches or epileptic spasms.
Neurologists said they could not rule out other possible explanations for McConnell’s seizures.
Dr. Gavin Britz, a neurosurgeon at the Houston Methodist Medical Center, said he would like to rule out Parkinson’s disease, which can also cause temporary paralysis attacks.
Benjamin Mueller – New York Times
Read the original article here.
