President James Madison.
Gilbert Stuart/Library of Congress
explainer / science

Medical Mystery: James Madison's Sudden Collapse

The Father of the U.S. Constitution fought a life-long physical battle, too.
In 1775, he attended a militia drill, but suddenly collapsed without warning. Similar episodes – marked by loss of function and subsequent collapse, or the appearance of day-dreaming, or even agitation – plagued Madison throughout his life.

What caused these episodes? Were they neurological or psychological? How did they affect his presidency?

Madison’s collapse at age 24 while on a military drill has been referred to as an “absence seizure” because the victim appears to momentarily be elsewhere. These seizures, a form of epilepsy also known as “petit mal” (from the French for “little illness”) usually are brief, often less than 15 seconds and barely noticeable, in contrast to other seizure disorders. Absence seizures begin in both sides of the brain at the same time, without warning.  They are so brief that they sometimes are mistaken for daydreaming and may not be detected for months.

Signs may include staring off into space, smacking the lips together, fluttering eyelids, suddenly stopping speech, and sudden motionless without being aware of surroundings, even when touched. According to the Epilepsy Foundation, about 65 percent of children with these seizures outgrow them in their teens. Medications can usually help to control them.

But, of course, those weren’t available to our fourth president, who was afflicted by these abrupt spells the remainder of his life. However, they didn’t affect his longevity, as he lived to a remarkable 85 years old.
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