While I knew that brain metastasis is a common feature of advanced melanoma, I did not know that a seizure is the most frequent first symptom of melanoma brain metastasis, more frequent than headache.
This was the first seizure of my life. None of those present could tell whether my first seizure was a stroke, so 911 was called, an ambulance arrived, and delivered me to the nearest emergency room. A CT scan soon revealed a mass in my right frontal cortex, the probable cause of the seizure.
Following Neurosurgery for resection of the mass, which was identified as metastatic melanoma, I remember being told, “do not drive so long as you are still taking narcotics for pain.” A printed OHSU Discharge Instruction confirms this memory was accurate.
Two weeks later, at the first follow-up with Neurosurgery, the Neurosurgery Fellow cautioned, “you have increased risk of seizure and should not drive for six months. You should also avoid solitary activities like walking” (and presumably bicycling, bus riding, coffee shop sipping, etc.)
“Wait a minute: Even though the suspected cause of seizure has been surgically resected and I am taking prescribed anti-seizure medicine, I’m now required to go to seizure jail based on elevated risk of seizure? Help me understand this situation.”
The Neurosurgery Fellow says “I am referring you to a Neurologist for seizure management. Someone from Neurology should be calling you in a few days.” Sure enough, a few days later, a scheduler named Julie called and offered the first available appointment, eleven weeks away on June 22nd.
Keppra (Levetiracetam 500mg) is the anti-seizure compound that I take twice a day. It is recommended for the treatment of epilepsy, especially for partial onset, myoclonic, or tonic-clonic seizures. Listed side-effects include drowsiness or dizziness; in my body Keppra causes severe drowsiness, peaking in an hour and lasting for about two hours. As a practical matter, this much drowsiness is probably more of a hazard for driving than risk of seizure. I wondered if this is an example of excessive medication.
I also wondered what Oregon law actually says about seizures and driving. I reviewed a Wikipedia article and found that Oregon law states:
“Seizures must be controlled for 3 months on medication or 6 months on no medication before driving. There is no longer a mandatory report for first time seizures. Conditions that are considered ‘severe and uncontrollable’ are subject to mandatory reporting by the driver’s primary care provider. Law enforcement agents may also file a report if there is an accident. Once reported, a Medical Certificate must be completed every 6 months to maintain driving privileges until the driver is released from surveillance.”
The definition of “severe and uncontrollable” is:
“Severe means that the impairment substantially limits a person’s ability to perform activities of daily living, including driving, because it is not controlled or compensated for by medication, therapy, surgery or adaptive devices. Severe does not include a temporary impairment for which the person is being treated by a physician or health care provider and which is not expected to last more than six months.”
“Uncontrollable means the impairment cannot be controlled or compensated for by medication, therapy, surgery, or adaptive devices.”
I recalled my seizure was brief (a couple of minutes) and severe (could have been a danger to myself and others if I had been driving). I don’t know whether it is uncontrollable. State law seems to rely on non-recurrence as proof of controllability: If I haven’t seized for 3 months with medication or 6 months without medication, then I’m controllable.
With this new information, I had a sudden epiphany. The simplest and best way to gain release from seizure jail was to contact my Primary Care Provider and work with him on creating a good-behavior plan to provide a balance of reasonable safety and more freedom. Thankfully he seems willing to cooperate and now I have an appointment for next week and am hopeful that my confinement can be put in good order and appropriate perspective. I don’t know if I’ll be driving again anytime soon, but at least I may be walking and traveling by mass transport.
Curious about what to do for someone in seizure? Take a glance at this helpful guide from the Center for Disease Control (CDC).