Could Vietnamese food have led to the death of Truro preschool teacher Edith Sweet?

David Gilman, also of Truro, may argue in September that monosodium glutamate — known as MSG — caused him to black out and drift across a double line on Route 6, causing the accident in which Sweet died on Nov. 9, 2007, according to court records.

Phenobarbital is a barbiturate that has the potential for addiction. It is the oldest antiepileptic drug in common use, dating from 1912, according to the Epilepsy Foundation. It is also a commonly prescribed drug for petit mal seizure.
Dilantin was developed in 1938 as the first modern antiepileptic drug, according to the Epilepsy Foundation. The medication can also produce difficulty in concentration, slow motor speed, unsteadiness, double vision and drowsiness at high levels.
A petit mal seizure, also known as absence seizures, is the result of abnormal neuronal activity on both sides of the brain. In this type of seizure, the person may appear to be staring into space and/or have jerking or twitching muscles, according to the National Institute of Neurological Disorders and Stroke.
Gilman, 64, ate Vietnamese food — which may have contained MSG — several times in the weeks before his Subaru Outback slammed into the driver’s side of Sweet’s Ford Escort, at 4:35 p.m. Rescuers declared Sweet, 55, dead at the scene as her 15-year-old daughter, Suzanne, a passenger, sat in the grass nearby, according to a police report. Gilman was conscious and breathing but did not respond immediately to rescuers’ questions.

MSG, a food additive, can cause headaches, rapid heart rates and dizziness, and the immediate, delayed or accumulated effect of glutamate — the active biochemical component — may have caused Gilman to black out, according to Brighton internist Dr. Walter Lee, Gilman’s physician. The glutamate may also have interacted negatively with one of the seizure medications Gilman was taking at the time, phenobarbital, Lee said in an April 21, 2008, letter to defense attorneys.

Gilman is charged with motor vehicle homicide by negligent operation, negligent operation of a motor vehicle and a marked lanes violation. He has denied use of alcohol, illicit drugs, herbs or medications other than those prescribed. His car was not going over the speed limit, according to court records.

After many months of delay due to medical treatments for Gilman, the jury trial date was set this week for Sept. 29 in Orleans District Court. At times since the crash, Gilman has been confined to a wheelchair and lost his memory of the crash, court records say. Neither Gilman nor his attorney, Augustus Wagner of Hyannis, appeared at the hearing Tuesday when the trial date was confirmed before a judge. Wagner did not return two phone requests for comment.

Proving negligence in the case will be key, said attorney Edward Ryan, Jr. of Fitchburg, past president of the Massachusetts Bar Association. Prosecutors need to show that a defendant either did something — or failed to do something — when “they ought to have known better,” Ryan said. Drinking alcohol and taking certain over-the-counter medications is a combination most people know to avoid when driving, but eating Vietnamese food isn’t, he said.

“I think it’s a very valid defense,” Ryan said.

Lee’s theory about MSG was part of the defense at a magistrate hearing in Orleans District Court in June 2008, according to court records. But Orleans Assistant Clerk-Magistrate Patricia Eldridge declined to determine its validity when she issued the criminal complaint against Gilman.

“As to the cumulative effect caused by an excess of MSG, the validity of that theory and all other aspects of the case are better left to the trial judge,” Eldridge wrote in a July 3, 2008, letter.

Since 1991, Gilman has taken phenobarbital and Dilantin to control his petit mal seizure disorder, Lee said in his letter. Gilman has controlled both medications very successfully, and in the past the phenobarbital worked best in the blood serum range of mid- to high-40s, he said.

“Mr. Gilman has gone as high as phenobarbital level 59 without any ill effects normally seen at that dose (like) drowsiness, dizziness, groggy sensation, ” Lee said in court records. “Mr. Gilman has remained seizure-free during all the years under my care. On November 9, 2007, Mr. Gilman recalled sudden loss of consciousness while driving without any bowel or bladder incontinence. At the time of his evaluation (at Cape Cod Hospital), his phenobarbital level was noted to be 62.”

Lee wrote that his patient had eaten at the Vietnamese restaurant two or three times a week, Lee said.

Lee said that the Vietnamese restaurant probably used MSG in the food, based on his personal experience as a member of a Chinese family of cooks, his medical school career near Chinatown in Boston and his Chinese and Southeast Asian medical clientele. Lee also said that glutamate can produce “less commonly observed” reactions and sudden, higher levels of phenobarbital in blood serum for patients taking the drug.

A request from the Times to the federal Food and Drug Administration for information about possible interactions between MSG and phenobarbital is pending.

The state Registry of Motor Vehicles requires that licensed drivers surrender their licenses for six months if they have had a seizure or other episode that affects their ability to drive safely. The license can be reinstated if a driver remains seizure-free for six months based on a letter from a physician, according to Registry spokeswoman Ann Dufresne.Gilman has an active Massachusetts driver’s license, according to state records. The Registry’s medical affairs department has no letters or records on file for him, Dufresne said.

                                                                                                                                 By Mary Ann Bragg