Millions of children and adults have seizures in the United States, but dying from one is rare. That only adds to the confusion and mystery surrounding the life and death of Jett Travolta, the 16-year-old son of actors John Travolta and Kelly Preston.
The death certificate lists a seizure as the cause of death, according to an undertaker in the Bahamas, where the boy died Friday. Family representatives and lawyers declined requests Tuesday for more information, fuelling speculation that has swirled for years about the boy's health.
A Travolta lawyer said the teen had a history of seizures, and John Travolta has said his son was successfully treated when he was two for a rare disease called Kawasaki syndrome, which can lead to heart disease and related problems.
Medical specialists who did not treat the boy told The Associated Press on Tuesday that while Kawasaki syndrome is poorly understood, it's extremely unlikely the disease had anything to do with the teen's death.
Gossip magazines and blogs long have suggested the boy also had autism - a claim John Travolta denied. Autism is frequently accompanied by seizures that experts believe may stem from the same brain abnormalities that cause the developmental disorder.
Dr. Michael Kohrman, a University of Chicago pediatric neurologist, said up to one-third of children with autism have some sort of seizure disorder.
Still, there are dozens of other causes of seizures. Recurrent seizures are sometimes called epilepsy and are caused by abnormal electrical activity in the brain. These affect more than three million Americans. Approximately 0.6 per cent of the Canadian population has epilepsy, the Epilepsy Canada website says.
Mild seizures can be barely noticeable; severe ones can cause convulsing and loss of consciousness.
"Sudden death in epilepsy is not an unheard-of phenomenon," said Dr. Bruce Cohen, a staff neurologist at the Cleveland Clinic.
It can happen with seizures lasting more than 15 or 20 minutes, typically when medicine stops working or if patients quit taking medicine, Cohen said. One way death occurs in these cases is respiratory muscles weaken from prolonged convulsions and the patient stops breathing, he explained.
More rarely, he said, about one in 1,000 epileptics die each year from a condition doctors call "sudep," or a sudden unexplained death that typically occurs with no sign of a seizure. Whether this happened to Jett Travolta or whether autopsy officials in the Bahamas know that term is uncertain.
"We're dealing with a massive lack of information," Cohen said.
Michael Ossi, an attorney for the Travoltas, and Samantha Mast, a Travolta publicist, told the AP by email that they would not discuss details of the boy's illness.
Jett Travolta's body was cremated, and the autopsy report has not been released.
The Travoltas have said little about their son's condition and his medical treatment over the years. The couple are Scientologists, followers of the controversial religion created by science-fiction writer L. Ron Hubbard.
The church is not commenting specifically on the Travolta case. But church policy is for members to seek a doctor for medical treatment of a physical condition, including taking any drugs prescribed.
"The bottom line is that Scientologists seek conventional medical treatment for medical conditions," said Tommy Davis, a spokesman for the Church of Scientology International in Los Angeles.
Kawasaki syndrome, the disease the family has said sickened Jett when he was a toddler, can cause inflammation in blood vessels and arteries. It typically features a persistent high fever accompanied by symptoms that can include bloodshot eyes; swelling in hands, feet and neck lymph nodes; a red rash on the arms and legs; and cracked, swollen lips.
Most cases occur in the first five years of life, and if treated promptly with aspirin and intravenous gamma globulin, children are essentially cured, said Dr. Cody Meissner, chief of pediatric infectious diseases at Tufts Medical Center in Boston.
While inflammation can sometimes lead to burst arteries or heart damage, Meissner said most children have no complications. And those who do would develop them soon after diagnosis - not several years later, Meissner said.
"If 10 years or more had gone by, it would be very unlikely that seizure activity could be attributed to Kawasaki disease," Meissner said.
Kelly Preston blamed household cleaners and fertilizers for the disease and said a detoxification program based on Scientology teachings helped improve his health, according to People magazine.
Meissner said there is scientific evidence linking professional-strength carpet cleaners with the disease.
Davis, the Scientology spokesman, acknowledged the detoxification program, but said its benefits are spiritual.
"Scientology is a religion," he said. "We deal with the spirit, and mental and spiritual factors that affect someone's happiness and well-being."