Despite his quick recovery from the seizure he suffered on Monday, Supreme Court Chief Justice John Roberts faces a complex diagnosis and a difficult decision.
Because the seizure was his second - he had a similar one in 1993 - he meets the criteria for epilepsy, and he and his doctors will have to decide whether he should take medication to prevent further seizures, according to neurologists not involved in his care.
(Neither the chief justice nor his doctors would comment Tuesday.)
The decision will involve weighing the risk of more seizures against the risk of side effects from the drugs. Major seizures can be a frightening and traumatic experience for both the patient and his family. Patients are advised to avoid heights and not to swim alone, and many states ban them from driving until they can provide proof that the disease is under control.
But the drugs can have troubling side effects, including drowsiness or insomnia, weight loss or weight gain, skin rashes, irritability, mental slowing and forgetfulness. Many patients can be treated with minimal side effects, doctors say, but it may take a process of trial and error to find the right drug.
The chief justice was released from Penobscot Bay Medical Center in Rockport, Maine, on Tuesday, one day after being rushed there from his summer home because of the seizure. A statement from the Supreme Court on Monday said that tests at the hospital had found "no cause for concern" and that the cause of the seizure was unknown.
About 2.7-million people in the United States have epilepsy, and the cause is unknown for 70 percent of them, according to the Epilepsy Foundation.
Neurologists sometimes describe seizures as an electrical storm in the brain, a brief episode of heightened activity that can cause mild symptoms that are barely noticeable, or loss of consciousness and convulsions, as in the case of Roberts.
"If he takes medication, he is likely to do fine and be seizure-free," said Dr. Gregory Barkley, a neurologist who specializes in epilepsy and is clinical vice chairman of the neurology department at Henry Ford Hospital in Detroit.
Barkley said he did not expect the illness or the treatment to affect the chief justice's ability to do his job.
But if Roberts' two seizures were 14 years apart, is another really likely, or likely to occur soon enough to warrant taking a drug every day? Neurologists differ.
Dr. Robert Fisher, director of Stanford's epilepsy center and a past president of the American Epilepsy Society, said: "In my view, it would be reasonable not to treat. It sounds like he went 14 years between seizures, and that's a lot of pills to take to prevent the next seizure 14 years from now."
Chief justice leaves Maine hospital
No word on drugs: The Supreme Court was mum Tuesday on whether Chief Justice John Roberts will need antiseizure medication - after he walked briskly out of a hospital in Maine and resumed his vacation. Roberts, 52, waved to onlookers outside the Penobscot Bay Medical Center in Rockport, Maine, before heading by pontoon boat to his summer home on Hupper Island. Hours earlier, he had assured President Bush by phone that he felt fine.
No cause found: The court said doctors found no tumor, stroke or any other possible cause. The definition of epilepsy is having two or more seizures with no other cause. Almost 3-million Americans meet that definition.
Medical problems can affect court
There are no indications that John Roberts will have trouble resuming his work, unlike the case of William O. Douglas - the clearest example of a case in which a justice's declining health did affect the workings of the court. The longest-serving justice, Douglas had a serious stroke on Dec. 31, 1974, but insisted he was still able to do the job. His colleagues believed otherwise. They dragged out deliberations in cases in which he was the decisive vote. Finally, 10 months later, unable to make it through court sessions, he quit.