“It may be necessary to undergo lifelong therapy”: neurologist explains Bayern star Jamal Musiala’s specific condition | Goal.com
Dr Becker previously worked at the neurology clinic at the University Hospital of Munich's Ludwig Maximilian University and now runs the "Munich Schwabing Neuro Centre".
Dr Becker, what was your first remote diagnosis when you saw footage of Jamal Musiala's collapse in the friendly against RB Leipzig on Saturday?
Dr Regina Becker: Because it happened so suddenly and he then obviously recovered quickly, as a neurologist I immediately thought of an epileptic seizure.
After the second collapse on Tuesday against 1. FC Heidenheim, Musiala confirmed that suspicion. In a public statement, he cited "temporary brief absences caused by a neurological dysfunction" as the reason. What exactly happens there?
Dr Becker: Absence epilepsy originates in the so-called thalamus, the diencephalon, which controls consciousness. Anyone who has a dysfunction there can suddenly become unresponsive. The brain enters an exceptional state, the neurons start firing uncontrollably, and communication between the thalamus and the so-called cerebral cortex, where we consciously perceive things, is interrupted. The patient no longer takes in their surroundings, stares into space or, as in Musiala's case, even falls over. To outsiders, the patient often appears frozen.
How does the patient experience such an incident?
Dr Becker: Most patients have no warning beforehand. It suddenly comes over them and they have no chance to react. Sometimes they do not even notice the seizure itself. Afterwards, they simply carry on as if nothing had happened.
If it comes on so suddenly, could it be that Musiala goes to take a penalty and simply keels over during the run-up?
Dr Becker: Yes, that is conceivable.
In both of his collapses so far during matches, Musiala was immediately substituted. Is that absolutely necessary from a medical point of view?
Dr Becker: In itself, the patient has no problem with the cardiovascular system, the organs function normally. Even so, in professional sport, carrying on is not possible for reasons of liability and duty of care. Factors such as heat and hyperventilation in particular could trigger further seizures, even if he himself is quickly fit again after a seizure.
Musiala is 23 years old and these problems were not previously known. Where have they suddenly come from?
Dr Becker: Normally, this form of epilepsy occurs between the ages of four and 10. However, there are also forms such as juvenile absence epilepsy, where the illness only appears later. In any case, 23 is late for a diagnosis. But of course we do not know whether this had also happened to him earlier and has now simply become more frequent and happened in public for the first time.
What could a sudden increase in frequency be due to?
Dr Becker: Provided there is a genetic predisposition, environmental factors such as high temperatures, dehydration or stress can contribute to the frequency of seizures increasing, or even to the first seizure occurring at all.
About a year ago, Musiala suffered a broken fibula. Could this very serious injury to a completely different part of the body have played a role?
Dr Becker: No, that has nothing to do with it.
In his statement, he himself writes that his illness is "treatable". Is that true?
Dr Becker: Yes, there are very promising medications for absence epilepsy. Most patients become completely seizure-free as a result.
How exactly does the treatment work?
Dr Becker: Patients are given what are known as seizure-suppressing medications, which prevent the uncontrolled firing of neurons and are intended to suppress epileptic seizures. They take the medication daily as a preventive measure, and it builds up the necessary level in the blood within two to three weeks. During this time, doctors carry out regular checks to see how the level is developing and whether the dose needs to be adjusted. Once that level has been reached, there is normally sufficient protection against further seizures.
How long do the medications have to be taken for?
Dr Becker: Even if the medications make someone seizure-free after a short time, they are taken for several months or years. In children who suffer from this form of epilepsy, there is a chance they will also become seizure-free in adulthood without medication. If the illness occurs later, lifelong therapy may be necessary. So the question cannot be answered in general terms, it varies from person to person.
Do the medications have side effects?
Dr Becker: The treatment of choice is ethosuximide. In principle, it is a very well-tolerated medication, but it can lead to headaches and tiredness. Valproic acid, which is also very effective, can have stronger side effects such as weight gain, hair loss or drowsiness. It has to be tried individually to see which medication is the best fit. Most patients tolerate both medications well.
Is there anything in the short or long term that would argue against Musiala continuing his professional career?
Dr Becker: No, with this form of epilepsy I have no concerns about his future career. In the adjustment phase of the medication, which is now presumably beginning, he will have to ease off a little so that the body has a chance to adapt.
In recent years, Musiala has regularly completed neuro-athletics training and spoken publicly in glowing terms about it. Could it be that he knew about his problems and wanted to counteract them that way?
Dr Becker: I can certainly imagine that he received the diagnosis some time ago and tried to compensate for it with neuro-athletics training. But if there is an increase in seizure frequency, that is not an effective preventive measure.
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