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Summary:Purpose: To determine whether the manic episode of patients with epilepsy has different characteristics from manic episode of patients with bipolar disorder.Methods: Interictal manic episodes in patients with epilepsy (epilepsy group) were compared with mood disorders in patients with bipolar I disorder (bipolar group), as defined by the DSM-IV. There were 13 patients (five women and eight men) in each group.Results: Five epilepsy patients had relatives with epilepsy and/or convulsions, and four bipolar patients had relatives with mood disorders. In the epilepsy group, two had substancerelated or organic factors associated with the episodes besides epilepsy, and two exhibited a postictal manic state that had the same symptoms as those of their interictal manic episodes. Ten patients of the epilepsy group had dependent-childish behavior.

We report a 9-year-old boy with a ring 20 chromosome anomaly whose complex partial seizures (CPS), presumably of frontal lobe origin, were often induced by playing video games. Neither photosensitivity nor pattern sensitivity was observed. An intensive video-EEG investigation showed that video games as well as mental calculation elicited rhythmic runs of bilateral high-voltage slow waves, which eventually evolved into ictal discharges. This case suggests that higher brain functions can be involved in seizure induction.

Summary:Purpose: To disclose possible epileptologic differences between photosensitive and nonphotosensitive patients with seizures induced by electronic screen games (ESGs).Methods: In patients with ESG-induced seizures who showed photo-and pattern sensitivity, magnetoencephalography (MEG) and EEG were performed simultaneously during ESG play, and equivalent current dipoles (ECDs) of the MEG spikes were estimated. In patients without ESG-induced seizures, who were surgical candidates, the intracranial EEG was analyzed for changes in epileptiform spike frequency.Results: Fifteen of 29 patients were photo-or pattern sensitive, and they had a posterior predominance of ECDs of the MEG spikes. In contrast, nonphotosensitive patients had an anterior predominance of ECDs. Other seizure-precipitating factors in the nonphotosensitive patients included hand manipulation or spatial processing. In patients without a history of ESG-induced seizures who underwent intracranial EEG monitoring for surgical evaluation, ESG playing induced changes in spike frequency in the supplementary motor area, perisylvian region, and medial temporal lobe.Conclusions: In photosensitive patients, interictal MEG spikes arise predominantly from the posterior region of the brain. In nonphotosensitive patients, epileptiform spikes tend to originate in the anterior part of the brain. Thus factors involving functions of the anterior part of the brain other than photo-or pattern sensitivity may play a role in the induction of seizures during ESG play. Furthermore, the changes in spike frequency in specific brain areas may correspond to their involvement in praxic activity and emotional changes during ESG play. A chance occurrence of seizures during ESG play also was observed. Key Words: Electronic screen game -induced seizures-Photosensitivity-Praxis sensitivity-Magnetoencephalography-Intracranial EEG.The most important factors contributing to the induction of seizures by video games or electronic screen games (ESGs) are photosensitivity and pattern sensitivity (1-3). The stimuli in the ESGs include flashing lights, rapid color changes, geometric patterns, and shifting scenes. In laboratory testing, some patients with ESGinduced seizures will show n o electroclinical evidence of pattern sensitivity or photosensitivity (2,4). In addition to general precipitating factors such as sleep deprivation and fatigue, nonphotosensitive factors such as proprioceptive stimuli from ocular muscles or eyelids, rapid and prolonged manual movements, emotional changes, psychic tension, and thought processing or decision making may have a role in the appearance of ESG-induced seizures in a minority of cases (5,6). The relevance of these factors has been poorly investigated, however. Harding (7) attributed the insensitivity to intermittent photic stimulation (IPS) or patterns to inadequate testing.Address correspondence and reprint requests to Dr. Y. Inoue at National Epilepsy Center, Shizuoka Higashi Hospital, Urushiyama 886, Shizuoka 420, Japan. E-mail: yushi@szec.hosp...