Bangor neurologist explains roots of epilepsy

BANGOR – Had Chief Justice John Roberts developed epilepsy in ancient Rome, he might have been ordered to drink the blood of a gladiator, according to Dr. Enrique Feoli, a Bangor neurologist who specializes in seizure disorders.

“They thought epilepsy was a sign that you were possessed by the devil,” Feoli said Tuesday. “Gladiator blood would give you the strength to rid yourself of that possession.”

Feoli, who practices with Neurology Associates of Eastern Maine and directs the epilepsy unit at Eastern Maine Medical Center, said people who experience seizures fall into two broad categories.

Those with “symptomatic epilepsy” have seizures related to an identifiable cause – a brain tumor, a stroke, an injury or some congenital condition such as mental retardation.

But for many others, apparently including Roberts, the condition is considered “idiopathic,” meaning its cause is unknown or uncertain.

“These are normal, walkie-talkie people. Their brains look normal, and we don’t know what’s going on, but they’re still having seizures,” Feoli said. As medical technology evolves, he noted, doctors are increasingly able to pinpoint fine scarring or other brain abnormalities not visible previously.

In any case, the mechanism of the seizure is the same. As Feoli explained it, the brain normally functions in a “chaotic” way, with nerve cells firing randomly. In a seizure, though, these neurons start firing in a synchronized fashion, setting off a multitude of abnormal responses. These can range from pronounced muscle contractions, rigidity and shaking accompanied by a loss of consciousness, to more subtle changes such as a sudden halt in activity or speech, brief episodes of staring and memory loss.

Feoli said the “vast majority” of people with epilepsy – defined as having experienced two or more seizures, regardless of how much time has elapsed between them – are managed effectively with medication. There are several reliable older drugs, but some newcomers are equally effective and produce fewer side effects. Side effects worsen if more than one drug is used and may include slowed cognitive responses and memory loss, as well as bone thinning and hearing loss, Feoli said.

If medications are not effective, doctors may suggest surgery to remove the section of the brain that is triggering the seizures. Feoli said there are also implantable electronic devices that are effective at derailing seizures as well as dietary changes that may help.

A diagnosis of epilepsy may mean giving up some activities, according to Feoli. Federal restrictions prohibit people with epilepsy from flying airplanes, driving big rigs or serving in the armed forces, he said.

Driving a private passenger vehicle is often the most difficult activity to forgo, and laws vary from state to state, Feoli said. In Maine, a person with epilepsy who has not had a seizure for six months or longer may legally get behind the wheel. People taking medications to control seizures may drive three months after their last episode, Feoli said.

Activities such as scuba diving, hang gliding and downhill skiing are strongly discouraged, he added.

In addition to all the medical and lifestyle complications of epilepsy, Feoli said, stricken individuals confront ignorance, suspicion and social stigma regarding their disorder. Negative attitudes reach back in time as far as ancient Rome, he said, when it was thought that epilepsy was a sign of demonic possession and could be cured by drinking the blood of a gladiator.

While such extreme notions have faded away, he said, the general public remains fearful. “Having epilepsy doesn’t mean you’re going to go on a rampage or drop dead on the job,” Feoli said. “It’s just a disease, like any other.”