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| Year : 2001 | Volume
: 49
| Issue : 4 | Page : 411-2 |
Video game epilepsy.
Singh R, Bhalla A, Lehl SS, Sachdev A
Department of Medicine, Govt. Medical College and Hospital, Sector - 32/B, Chandigarh - 160032, India.
Correspondence Address:
Department of Medicine, Govt. Medical College and Hospital, Sector - 32/B, Chandigarh - 160032, India.
Reflex epilepsy is the commonest form of epilepsy in which seizures are provoked by specific external stimulus. Photosensitive reflex epilepsy is provoked by environmental flicker stimuli. Video game epilepsy is considered to be its variant or a pattern sensitive epilepsy. The mean age of onset is around puberty and boys suffer more commonly as they are more inclined to play video games. Television set or computer screen is the commonest precipitants. The treatment remains the removal of the offending stimulus along with drug therapy. Long term prognosis in these patients is better as photosensitivity gradually declines with increasing age. We present two such case of epilepsy induced by video game.
How to cite this article:
Singh R, Bhalla A, Lehl S S, Sachdev A. Video game epilepsy. Neurol India 2001;49:411 |
Reflex epilepsy is the commonest form of seizures provoked by specific external stimulus or event. Around 5% of epileptics show some features of precipitation of seizure in response to external stimuli which include flashing lights, other visual stimuli, startle, eating, bathing in hot water, reading, music and movement.[1] Photosensitive reflex epilepsy is provoked by environmental flicker stimuli,[2],[3] generalised epileptic discharge is evoked by intermittent photic stimulation, constituting a photoconvulsive response.[4] Photosensitive reflex epilepsy constitutes 10% of all new cases of epilepsy presenting in the age group of 7-19 years.[5] It is a relatively rare kind of epilepsy with an incidence of 1:4,000 of general population.[2],[6] The attacks are precipitated by flickering or patterned stimuli; the most common precipitant is television. This may in addition, be associated with sleep deprivation, stress or other causes of lowered convulsive threshold.[7] About 50% individuals have normal baseline EEG with abnormality appearing on intermittant photic stimulation.[8]
Video game epilepsy is almost similar to photosensitive epilepsy. Some investigators consider this to be an extension of photosensitive reflex epilepsy while others consider this to be a form of pattern sensitive epilepsy. Television or computer screen is the commonest precipitants. Ruston first described an epileptic attack precipitated by video game in 1981, while Jeavons described a first case of epilepsy induced by a small hand held video game.[2] Since then, the reports have risen steadily. We present two such cases of epilepsy induced by video game.
Case 1 : An 18 year old boy was brought to the emergency of Government Medical College, Chandigarh in October 1999 with history of unconsciousness since morning. No definitive history of events preceding unconsciousness was available immediately and the possibility of head injury, metabolic disturbances or poisoning was considered. The patient was in grade IV coma; without any evidence of focal neurological deficit or papilloedema. All haematological and biochemical parameters were normal. He regained consciousness after 6 hours. Abnormal movements of his left half of the body were noted which lasted for few minutes and were followed by confusion. He was treated with phenytoin and diazepam during this period. He did not have any recurrence of seizure. It was later revealed by the patient that he had played video game (Virtua cop 2, SEGA games) at home, on personal computer, for hours in the evening prior to the episode and was found unconscious by his parents in his bed the next day. Since he slept alone, no one had noticed seizures during night time. With this history a diagnosis of photosensitive reflex epilepsy was made and patient was subjected to EEG, which revealed classical photoconvulsive response during intermittent photic stimulation. He was put on sodium valproate, 600 mg per day in three divided doses, and has been seizure free since then.
Case 2 : A 12 year old boy was playing video game (Super Mario Bros.) using the domestic television screen attached to a video game unit for 3 hours continuously and developed two episodes of generalised tonic clonic seizures. He was brought to emergency in a confused state. He had no focal neurological deficit. There was no history of such attacks in the past and there was no family history of seizures. His sensorium improved over next 4 hours. EEG revealed a classical response on photic stimulation. He was put on sodium valproate, 600 mg per day and has been seizure free since then.
Video game epilepsy is an uncommon type of seizure disorder, which is an extension of photosensitive reflex epilepsy. Domestic television set provides almost optimal conditions for provoking an attack, particularly if viewed closely or with room lights switched off. Most video display units have refresh rate of 70 Hz, no line interlace pattern and phosphors content lower than that used in television sets and are thus less epileptogenic.[8] Many individuals view the television set or computer screen more closely while playing video games than while viewing the telecast. The most common seizure type is generalised tonic clonic seizure (84%) compared to absence (6%) and myoclonic jerks (2%).[9] It has been proved that seizures can be induced by specific patterns in video materials. It is recommended that all the patients presenting with video game induced epilepsy should be tested in the EEG laboratory for photosensitivity as well as sensitivity to various pattern shifts. If the precipitating factor or the video game is available it should also be used to test the sensitivity of the particular patient in the laboratory.[10] Removal of the offending stimulus along with drug therapy remains the treatment of choice. Standard method of therapy is avoidance of precipitating stimulus. Viewing television from a distance of more than two meters in a well-lit room, avoidance of frequent setting or adjustments, covering one eye when there is flickering stimulus also helps. Sodium valproate is the most useful drug in treatment of this kind of epilepsy.[11] Drug therapy with valproate abolishes reflex photosensitivity but any change in the pattern of this kind of epilepsy or evidence of focal seizures should warrant an investigation for underlying focal neurologic lesion. Long term prognosis in these patients is better, as photosensitivity gradually declines with increasing age.[8]
International workshop convened in response to public concern issued a consensus statement offering following guidelines.[12]
1. While playing video game with conventional video display device, the subject should use a smaller screen not more than 12 inches; if a larger screen is used the viewing distance of atleast four times the screen diameter should be maintained.
2. Prolonged play, more than 1 hour per session, should be avoided.
3. Avoid playing the game if suffering from lack of sleep, fever or hunger.
4. If family history of photosensitivity is present, avoid playing video game till EEG examination including a period of patterned photic stimulation has been carried out to determine photosensitivity.
5. If shown to be photosensitive, patient should avoid playing games known to precipitate seizures, take precautions to avoid seizure precipitation and play games under the supervision of an adult capable of managing an acute seizure.
| 1. | Chaudhary N, Narayana RV, Shah PU : Photosensitive reflex epilepsy. JAPI 1999; 47 : 336.  |
| 2. | Jeavons PM, Harding GFA : Photosensitive epilepsy. Clinics in developmental medicine. Heinemann Medical, London. 1975; 56. |
| 3. | Newmark ME, Penry JK : Photosensitivity and epilepsy : a review. Raven press, New York. 1979. |
| 4. | Bickford RG, Daly D, Keith HM : Convulsive effects of light stimulation in children. Am J Dis Child1953; 86 : 170-183. |
| 5. | Duncan JS, Shorvon SD, Fish DR : Clinical epilepsy. BI Churchill Livingstone Pvt. Ltd. New Delhi. 1955; 66-67. |
| 6. | Hearding GFA : Photosensitive epilepsy. In : Research in psychology and medicine. Osbome DJ, Ciruneberg MM, Eisser JR (eds). Academic press, London 1980; 370-376. |
| 7. | Henchey RA, Gilmore RL : Video game epilepsy following temporal lobectomy. Electroencephalogr Clin Neurophysiol 1993; 86 : 29. |
| 8. | Binnie CD : Simple reflex epilepsies. In Epilepsy : a comprehensive textbook. Engels J Jr and Pedley TA (ed.). Lippincot-Raven publishers, Philadalphia. 1997; 2489-2505. |
| 9. | Binnie CD, Jeavons PM : Photosensitive epilepsies. In : Epileptic syndromes in Infancy, childhood and adolesence, 2nd ed. Roger J, Bureau M, Dravet C et al (eds.) John Libbey Eurotext, London. 1992; 299-305. |
| 10. | Hearding GFA, Jeavons PM, Edson AS : Video material and epilepsy. Epilepsia1994; 35 : 1208-1216. |
| 11. | Hearding GFS, Herrick CE, Jeavons PM : A controlled trial of sodium valproate on photosensitive epilepsy and its prognosis. Epilepsia 1978; 19 : 555-565. |
| 12. | Binnie CD, Harding GFA, Wilkins A et al : Video games and epileptic seizures-a consensus statement. Seizure1994; 3 : 245-246. |
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