DEAR DR. DONOHUE: I have a relative who has epilepsy. She didn’t have it as a child. How did she come down with it? I know a little about grand mal epilepsy, but I would like to know more. How does it differ from other kinds? Does a person have to take medicine for life? – K.K.

ANSWER: All seizure disorders (epilepsy) come from a sudden discharge of electrical energy from brain cells. In a tonic-clonic (formerly called grand mal) seizure, the wave of electrical energy spreads across most of the brain rather than a discrete area. The seizure begins abruptly, and the person generally falls to the ground. At first, muscles are rigidly contracted – the tonic phase. Ten to 20 seconds later, there are jerking movements of the body and limbs – muscles are contracting and relaxing – the clonic phase. A seizure lasts about a minute, and the patient gradually regains consciousness, although he or she might be confused for a time. Tonic-clonic seizures can begin at any time in life, even old age. They often follow a stroke. The brain scar that forms after a stroke can serve as a trigger for them.

Another kind of generalized seizure is the petit mal variety. It is now called an absence seizure. It consists of sudden, brief lapses of consciousness without falling to the ground. The event can be as short as a second, and during the seizure, the eyes might blink rapidly or the mouth make chewing movements. Quite often, bystanders don’t recognize that anything is happening, or they think that the affected child is daydreaming for a second or so. Absence seizures mostly begin in childhood and remit, 60 percent to 70 percent of the time, when the child grows older.

There are at least seven other varieties of seizures.

An adult who has had only a single seizure that was more than two years ago and who has a normal neurological exam can be considered for a trial of medicine discontinuation.

DEAR DR. DONOHUE: I have a 37-year-old brother who has been an alcoholic since he was 17. He has not had a job for the past three years. He lives in a subsidized apartment. Four weeks ago, I couldn’t reach him, so I went to his apartment and found him undressed and completely out of it. He wasn’t drunk. I took him to the hospital, and they said he had Wernicke’s syndrome. I’ve never heard of this. Can he get better? – M.H.

ANSWER: Wernicke’s syndrome comes from a deficiency of the B vitamin thiamine. In Third World countries, it comes from malnutrition due to inadequate food supplies. In developed counties, alcoholism accounts for most cases.

Chronic alcohol use can destroy parts of the brain, and that produces great unsteadiness, disorientation, loss of the ability to concentrate and difficulty moving the eyes in tandem – all signs of Wernicke’s.

In some instances, Wernicke’s is an emergency. Without prompt treatment, people can become stuporous and die.

Treatment is massive doses of thiamine given by injection.

About half of those treated will recover. It is close to impossible, however, to predict who will recover and who will continue living with some Wernicke’s symptoms.

DEAR DR. DONOHUE: I have type 2 diabetes and take a pill for it. My blood sugar is always good. I have developed carpal tunnel syndrome, and my doctor suggests giving me a shot of cortisone for it. I have been told that diabetics should never take cortisone. If I take this shot, what will it do to my diabetes? – T.Z.

ANSWER: Carpal tunnel syndrome is the wrist problem that causes painful or numb fingers and can interfere with finger movement.

Cortisone, the most powerful anti-inflammatory medicine available, antagonizes the secretion and action of insulin. Therefore, it can upset a diabetic’s sugar control. However, the kind of cortisone used for treatment of carpal tunnel syndrome is a long-acting kind that does not cause sudden, high blood cortisone levels. It is less likely to upset blood sugar. Most diabetics are now checking their own blood sugars, so they can rapidly detect any blood sugar upset and attend to it promptly – cortisone-induced or not. You can safely take the shot.

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.