Viewpoint: Dr. Alan Ettinger offers Prognosis for "Victor Newman"

By Alan Ettinger, M.D.
Special to EpilepsyUSA
Posted: August 29, 2006

As the director of the North Shore-LIJ Comprehensive Epilepsy Centers on Long Island, N.Y., Dr. Alan Ettinger, spends much of his day trying to help individuals with epilepsy. EpilepsyUSA recently sent him the script for the episodes of The Young and the Restless and asked him to watch the episodes with a critical eye. Quick to point out that nobody can properly diagnose a character on a television show, Dr. Ettinger agreed to offer his comments about the character who portrays someone with epilepsy.

What do you think is the prognosis for this character?

The vast majority of individuals with epilepsy become seizure-free with proper medical management, so I would be optimistic for the character, Victor. Therefore, it's quite possible that Victor would become seizure-free. It's very important for individuals who develop epilepsy in middle age to make sure the doctors are asking the question why the epilepsy developed in the first place. While we don't necessarily arrive at an obvious reason, it's very important to exclude uncommon but serious conditions that can give rise to seizures in this age group, such as a brain tumor. As we get older, into our sixties and beyond, vascular disease becomes more of a likely diagnosis. That's why it's very important to take adequate pictures of the brain with an MRI. Relying just on a CAT scan should not be considered sufficient in the diagnostic evaluation.

Victor had a seizure while he was hooked up to an EEG, and then the doctor wrote a prescription immediately. Can the diagnosis and the prescription happen as quickly as it was portrayed in the episode?

It's more likely that you will pick up a seizure if you do a much more prolonged EEG (electroencephalogram). And that's why specialized epilepsy centers provide this extended EEG (video-EEG) monitoring. However, even with the most sophisticated equipment, the best job that a physician can do is to take a detailed history and perform a complete physical examination. Normally, the EEG will indicate clues about the presence of the risk for epilepsy. In this soap opera, the doctor was lucky to capture an actual seizure while the EEG was running.

This enabled the doctor to see the changes on the EEG that go along with a seizure. But the diagnosis is not based exclusively on the EEG. As mentioned, the doctor needs to take a very detailed history of the patient. That requires asking an individual to describe step-by-step what he or she experiences from start to finish, and what is experienced after the seizure. It is also very valuable to get an account from witnesses of the seizures.

How common are the character's symptoms for someone with temporal lobe epilepsy (TLE)?

There are classic symptoms associated with temporal lobe seizures and then there are other fairly classic symptoms associated with seizures that occur from areas outside the temporal lobe.

Obviously, the writers of the script have chosen to use their poetic license to create symptoms that are extremely rare. Victor is apparently seeing a recurrent image of a distinct person from his past. This is an unusual manifestation of seizures. The scene that was a little more realistic was when he inadvertently keeps his hand over a flame in the fireplace. During some seizures, people with epilepsy may have an altered sense of one's awareness and so those kinds of accidents can occur. It really speaks to the need for proper treatment.

Do you believe that the character's portrayal is an inaccurate depiction of people with epilepsy?

There are merits and deficits to this kind of portrayal. Some of the advantages are that people understand how epilepsy can afflict any one of us. Even the most vigorous, best-looking and talented people can have epilepsy. It may also be valuable to show the public that seizures are not necessarily characterized by major convulsions, such as shaking, tongue biting or incontinence. The show does highlight the fact that there is a wide variety of ways that seizures can manifest themselves. Even the doctor discusses this during one segment.

Another important aspect of the show was how the doctor advised the daughter what to do if a seizure were to recur. He appropriately indicated for example that she should never ram anything into someone's mouth during a seizure.

I also felt there were concerns about the portrayal of Victor's seizures. Some could come away from these episodes concluding that seizures are a healthy way of transforming one's personality from a bitter or angry one, to a likeable and personable one. It's also a mistake to believe that there is some advantage to avoid taking antiepileptic medications because it is good for one's personality.

In the end, however, I'm gratified that CBS did partner with the Epilepsy Foundation to create a public service announcement aired after the episodes about epilepsy.

What are some of the dangers of not taking medication?

There are some very big concerns! Seizures should never be considered as simply a nuisance which otherwise creates no problems. Unfortunately, if left unchecked, seizures can become extremely severe or very prolonged. The result may be complications for both the brain and for the rest of the body. So, epilepsy is not just something that interferes a little bit with one's life. Instead, it has important health implications and really needs to be adequately addressed.

It is possible, since we are only seeing the very beginning of the character's seizures that his epilepsy could progress and develop into a secondary generalization. In other words, the seizure discharges could begin to involve more of his brain which could result in generalized convulsions.

If the character continues to have an impairment of consciousness during the seizure, there are other complications that can occur. For example, the character could walk into traffic or burn himself again at the fireplace.

What kind of medication might be prescribed for the character?

The purpose of giving medications in epilepsy is not to treat the seizure that has occurred already, but rather to try to prevent further seizures from occurring. One concern in the TV show was that the doctor didn't discuss the risks and benefits of the medicine he prescribed. He also did not discuss potential drug interactions or indications for calling the doctor if further problems were to occur. Ironically, this unfortunately was a very realistic portrayal of what often happens in the doctor's office. Individuals should insist on reviewing these issues with their doctor. A checklist of items to discuss with the doctor may be found at www.epilepsylongisland.com. The doctor usually will order some baseline and subsequent blood tests.

With regard to treatments, there should also be discussions of general categories of treatment, such as medical and surgical. Many physicians unfortunately do not promote awareness of potentially curative surgical options. And there are a broad range of anti-epilepticmedications that are available.

What are some of the character's other choices for treatment?

If the character demonstrates a persistence of these seizures in spite of adequate trials of anti-seizure medications, he may be a candidate for a surgical intervention. The definitive surgery involves trying to locate where the seizures are coming from. This requires a very comprehensive set of tests that are rendered at specialty epilepsy centers. Then the area in the brain that is giving rise to seizures is removed. This procedure may actually offer the possibility of a cure for epilepsy.

An alternative, more minor surgical therapy is called the vagal nerve stimulator (VNS). While the latter tends not be curative, it may reduce the severity and frequency of seizures and may even lead to an improvement in mood.