DEAR DR. DONOHUE: I am the mother of five boys, and the youngest is 23. He graduated from college this year. He was discovered to have a seizure disorder and is now under treatment for epilepsy. No one in my or my husband’s family ever had it. How will this affect his life? Must he stay on medicine forever? – J.A.

ANSWER: Epilepsy is the result of a sudden discharge of electrical activity in the brain’s nerve cells. In most cases, family history of it is not found. Tracking down a cause is often a pursuit that ends fruitlessly. An old head injury might be responsible. People who have had strokes can develop brain scars that lead to it. Malformations of the brain are another possible cause.

Epilepsy is not one disorder. It has many different manifestations. Some seizures are so subtle that people can have one without bystanders ever detecting it. Other seizures are more dramatic. They cause patients to fall to the ground, often with a loud grunt. The arms and the legs stiffen temporarily. That short phase is followed by a stage of jerking movements of the arms and legs. The seizure is often more distressing to observers than it is to the person experiencing it.

Epilepsy complicates life. There is no glossing over that, but every illness does — diabetes, for example. Most patients lead long and fulfilling lives in all spheres. Epilepsy patients are professional athletes, doctors, lawyers, teachers, carpenters and on and on. Your son’s opportunities are not much different from the ones he had prior to his diagnosis.

Medicine is often a lifelong commitment. However, experts have designed a profile of an epilepsy patient who might successfully stop taking medicine. If a person has had only one or a few seizures, if the seizures have been controlled with one medication and if seizures began at an early age, there is a good chance that weaning from medicine is possible. Almost all protocols for eliminating medicine require that patients be seizure-free for at least two years. The success rates for stopping medicines range from 34 percent to 77 percent.

DEAR DR. DONOHUE: I understand that a big belly indicates heart trouble. How big? Where is the measurement taken? – P.G.

ANSWER: A waist measurement greater than 40 inches (102 cm) in men and 35 inches (89 cm) for women is considered to be a sign of heart disease.

Where’s the waist? If you want to be precise, it is at the top of the iliac crest. The iliac crest is the bone you can feel on the side of the lower abdomen. If you can’t feel the iliac crest, use the navel as the site of the waist. Incidentally, this is not the same site tailors use in measuring waists.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

DEAR DR. DONOHUE: Prior to getting my present job, I had to have a medical examination. As part of the exam, blood was taken for lab tests. I got the job, but the examining doctor wants me to come back for a follow-up visit. He suspects I might have Gilbert’s disease. I know nothing about this illness. Please set me straight about all this. Is this a serious condition? – V.B.

ANSWER: Gilbert’s should not be called a disease or a syndrome. “Oddity” is a more appropriate word.

From time to time, people with this condition will have a yellowing of the whites of their eyes, and light-skinned people will see their skin turn yellow. The color is due to a blood-level rise of bilirubin. Bilirubin is a pigment, and it comes from the recycling of worn-out red blood cells. Ordinarily the liver siphons off bilirubin and disposes of it.

People with Gilbert’s have a liver with a slight hitch. Now and then their livers falter in removal of bilirubin from the blood. That’s when the eyes and light-colored skin turn yellow. Aside from giving people a scare when they see themselves in the mirror, the bilirubin causes no damage.

Alcohol can sometimes spark a yellowing period. So can fasting.

To put the diagnosis of Gilbert’s disease on firm ground, a doctor can put the patient on a very low-calorie diet for two days and then have blood drawn for a bilirubin determination. A rise indicates Gilbert’s.

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