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Faculty Focus

Gregory Holmes, M.D.: Myth buster

By Laura Stephenson Carter

The hero of the week is Chicago White Sox trainer Herm Schneider, who saved first baseman Greg Walker's life by prying his mouth open with scissors to keep him from swallowing his tongue after Walker suffered a seizure during pregame warm-ups." So reads the "Inside Baseball" column in the August 15, 1988, issue of Sports Illustrated (SI).

Epilepsy expert (and sports fan) Dr. Gregory Holmes wasted no time in shooting off a stern letter to the editor, which SI published a month later. "While Schneider deserves praise for his willingness to help, his actions were incorrect and could have causedWalker considerable harm," Holmes wrote. "It is a myth that you can swallow your tongue during a seizure. You cannot swallow your tongue during a seizure," he emphasized. "What's more, the mouth should never be pried open, and especially not with a sharp object."

Holmes, who since 2002 has been a professor of medicine and of pediatrics at DMS and chief of neurology DHMC, admits that seizures can be terrifying to watch. Even for someone like him who has seen thousands of them. He's spent his career treating people with epilepsy, doing research on the underpinnings of the disorder, and trying to dispel some of the myths that surround it.

"The problem is you can't do much, which makes it very frightening," says Holmes, who is a past president of the American Epilepsy Society. "You don't want [people having a seizure] to hurt themselves. Don't stick anything in their mouth," he cautions. "Just turn them on their side and wait for it to end."

Epilepsy is one of the most misunderstood disorders, Holmes says. People think it's contagious, that it causes mental derangement, that someone with epilepsy can't live a normal life. And then there's that persistent swallowing-their-tongue myth. It's all untrue.

Holmes's first encounter with epilepsy was when he was in high school. A fellow student "unfortunately had a couple of grand mal seizures in the classroom and fell out of her seat, urinating and jerking," he says. "What was really bad was the teacher didn't know what to do." The other students learned to ignore the girl's seizures and "pretended it wasn't happening. But . . . then we tried to ignore her when she wasn't having a seizure. So

Dartmouth's Greg Holmes, now a nationally known expert in epilepsy, recalls feeling helpless and scared when a high-school classmate had an epileptic seizure during class.

she became an outcast and had no friends in the class, even though she was a really nice girl. It was this terrible feeling of ignorance, knowing that something bad was happening. We just didn't want to be around her.

"I was just as scared as everyone else," Holmes admits. "But I wasn't scared to go into medicine. I wanted to learn more so I wouldn't be scared."

As Holmes embarked on his medical training in the early 1970s, the field of epilepsy treatment was evolving rapidly. Through the 1960s, people with epilepsy typically relied on a couple of drugs—dilantin and phenobarbital—to control their seizures, but those drugs had unpleasant side effects. Since then, new and more effective medications have been developed. "There's a lot more interest in understanding the mechanisms of epilepsy, and that led directly to

treatments," Holmes says. Today's approach to epilepsy "makes a lot of sense once you understand how seizures occur," he adds.

Epilepsy—which affectsmore than twomillion people in theUnited States, according to the National Institute of Neurological Disorders and Stroke—is a brain disorder in which clusters of nerve cells, or neurons, fire electrical impulses at higher-than-normal rates. This is what causes the seizures. But not all seizures are of the so-called grand mal, or tonic-clonic, type that Holmes observed in his highschool classmate all those years ago. Some can be as mild as staring off into space for a few moments.

Seizures are just this incredible spread of synchronous electrical activity," says Holmes. As a result, "cells that were not normally supposed to wire together do wire

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Laura Carter is the associate editor of Dartmouth Medicine magazine.

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