A four-line letter, signed by Congress’s incoming physician and released by Senator Mitch McConnell on Thursday, suggested that his recent spells of speechlessness were related to “occasional dizziness” possibly caused by his recovery from a concussion last winter or “dehydration. .”
But seven neurologists, relying on what they described as the extraordinary revelation of the video of Mr. McConnell, who has publicly frozen out twice recently, said in interviews Thursday and Friday that the episodes captured in real time likely point to a more serious medical problem plaguing the longtime Republican leader.
Some of the neurologists, while cautioning that they could not diagnose the minority leader from afar, said the letter and other comments from Mr. Wednesday
“If I gave that tape to a medical student and that was his explanation, I would fail him,” said Dr. Orrin Devinsky, a professor of neurology at the NYU Grossman School of Medicine, referred to the account provided by the incoming congressional physician on Thursday. “Medically, these episodes need to be taken seriously.”
Neurologists say that episodes justify close medical attention and may prompt treatment to prevent them from recurring. While several possibilities have been suggested, including mini-strokes, doctors say the spells appear most consistent with focal seizures, which are electrical surges in one region of the brain.
The senator’s aides did not disclose what kind of follow-up care Mr. McConnell might receive. Doug Andres, a spokesman for the senator, said Friday that he had nothing to add to the letter from the congressional physician, Dr. Brian P. Monahan, who is not respond to requests for comment.
More details about the medical history of Mr. McConnell, 81, including whether he was having such episodes off camera, would also help rule out other possible explanations for the spells, neurologists said.
Whether caused by seizures or mini-strokes or something else, spells like Mr. McConnell won’t prevent most patients from working or socializing normally, doctors say.
“Seizures have a stigma in our society, and that’s unfortunate because they are very brief electrical disruptions in behavior,” said Dr. Jeffrey Saver, a professor of neurology at UCLA “Between the rare episodes, which are usually well controlled by drugs, people function perfectly normally.”
However, experts say that seizures carry some high risk of cognitive or behavioral problems and may affect older patients differently.
Rarely does the public see a serious medical event in a public figure as it has twice in recent weeks with Mr. McConnell. For neurologists, videos like those showing Mr. McConnell from the moment he appeared speechless was more than just curiosities.
They can help form the basis of a diagnosis, just like the homemade videos of everyday patients that are occasionally made in routine neurology practices.
“They are very helpful, because you are not subject to the wonders of someone’s description and you can get the beginning of it, which is important especially for seizures,” said Dr. Anthony Kim, a professor of neurology at the University of California, San Francisco.
Details as small as the direction in which people’s eyes are focused during such an episode offer potential clues about the cause, Dr. Kim.
After watching the symptoms of Mr. McConnell playing — his sudden halt in speech, his eyes staring into the distance, his seeming recovery after about 30 seconds — said Dr. Kim that “the possibility at the top of my list is a seizure.”
That the second spell of Mr. McConnell very closely mirrors the first one that taught stronger in a seizure, neurologists said.
Mini-strokes, which result from a blood clot that reduces blood flow to the brain, can also cause short periods of speech impairment. But they rarely produce the same constellation of symptoms each time they recur, because clots are unlikely to travel randomly to the same part of the brain twice.
Focal seizures, on the other hand, are often triggered by an irregularity in a specific part of the brain, creating what doctors refer to as stereotypic symptoms. They have been known to stop patients dead in their tracks, seemingly cutting them off from their surroundings.
Patients are often able to respond to questions during such an episode — as Mr. McConnell did on Wednesday, saying “yes” when asked if he heard a reporter’s question — even if they don’t seem able to say the word. their thoughts or engage with their environment.
Mr. McConnell suffered a concussion in March, a risk factor for seizures. Seizures can be caused by bleeding in the brain or a scar from a traumatic head injury. Previous strokes or other types of brain tissue damage can also lead to seizures in older people, who as a group experience the onset of seizures almost as often as children.
Some seizures are triggered by triggers such as abnormal blood sugar levels. But if a person has two seizures that can’t be explained that way, neurologists say that’s usually enough for a diagnosis of epilepsy, a common neurological disorder that affects more than three million Americans and can appear at any age. . They will usually prescribe anti-seizure medication.
“There are two seizures you really want to treat,” says Dr. Sami Khella, the chief of neurology at Penn Presbyterian Medical Center. “You don’t want them to happen — they’re not good for you.”
Many patients function completely normally and show normal brain wave activity between seizures, allowing them to remain active and functional. although some may turn away from activities such as driving.
But these cause patients to miss periods in episodes. A seizure at an inopportune moment, such as when crossing the street, can be dangerous. And focal seizures involving one region of the brain can generalize, causing episodes characterized by jerking movements or epileptic spasms.
Beyond that, one or two seizures can lead to more, a cycle that neurologists try to interrupt with treatment. “The more the brain seizes, the more it learns to seize,” said Dr. Khella.
Other complications may follow. A phenomenon known as sudden, unexpected death in epilepsy kills an estimated one in 1,000 people with epilepsy each year.
“If you develop epilepsy as an elderly individual, there are concerns about things like memory, about cognitive function, because your resilience at 80 will be less than when you’re 20 or 30,” said Dr. Devinsky, who directs NYU Langone’s Comprehensive Epilepsy Center.
Neurologists said they could not rule out other possible explanations for Mr. McConnell.
said Dr. Gavin Britz, a neurosurgeon at Houston Methodist, wants to rule out Parkinson’s disease, which can also cause freezing episodes.
But neurologists agree that the suggestions that Mr. McConnell just lost his head, while possible, is difficult to compare to the video. Dehydration can make other conditions worse, they say, but such patients are unlikely to stay upright or recover as quickly without fluids, as Mr. McConnell did.
“We don’t have 100 percent information, so we’re kind of in the dark,” said Dr. Devinsky. “But we have this very powerful clinical information, which is very honest to how I have to diagnose seizures and epilepsy all the time, often without video.”
