Mechanisms of Video‐Game Epilepsy

Fylan, Fiona; Harding, G. F. A.; Edson, A. S.; Webb, Ruth M.

doi:10.1111/j.1528-1157.1999.tb00903.x

Cited by 29 publications

(18 citation statements)

References 6 publications

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“…The photoparoxysmal responses are essentially elicited by patterned photic stimuli with high spatial frequency mostly stimulating P cells. 27 The OSs generally produced by 8 to 20 flickering stimuli are phase-locked to the stimulus and mostly processed by M cells. 24 High temporal frequency steady state oscillations observed in subcortical (LGN and optic radiation) and cortical (V1/V2 complex) areas in our three nonphotosensitive epileptic patients share the following essential properties with OSs.…”

Section: Discussionmentioning

confidence: 99%

Human lateral geniculate nucleus and visual cortex respond to screen flicker

Krolak‐Salmon

Hénaff

Tallon‐Baudry

et al. 2002

Annals of Neurology

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The first electrophysiological study of the human lateral geniculate nucleus (LGN), optic radiation, striate, and extrastriate visual areas is presented in the context of presurgical evaluation of three epileptic patients (Patients 1, 2, and 3). Visual-evoked potentials to pattern reversal and face presentation were recorded with depth intracranial electrodes implanted stereotactically. For Patient 1, electrode anatomical registration, structural magnetic resonance imaging, and electrophysiological responses confirmed the location of two contacts in the geniculate body and one in the optic radiation. The first responses peaked approximately 40 milliseconds in the LGN in Patient 1 and 60 milliseconds in the V1/V2 complex in Patients 2 and 3. Moreover, steady state visual-evoked potentials evoked by the unperceived but commonly experienced video-screen flicker were recorded in the LGN, optic radiation, and V1/V2 visual areas. This study provides topographic and temporal propagation characteristics of steady state visual-evoked potentials along human visual pathways. We discuss the possible relationship between the oscillating signal recorded in subcortical and cortical areas and the electroencephalogram abnormalities observed in patients suffering from photosensitive epilepsy, particularly video-game epilepsy. The consequences of high temporal frequency visual stimuli delivered by ubiquitous video screens on epilepsy, headaches, and eyestrain must be considered.

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Section: Discussionmentioning

confidence: 99%

Human lateral geniculate nucleus and visual cortex respond to screen flicker

Krolak‐Salmon

Hénaff

Tallon‐Baudry

et al. 2002

Annals of Neurology

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“…In a comparison of the sex distribution of a group of 11 patients (seven males and four females) with pattern sensitivity to 34 patients (13 males and 21 females) with pattern sensitivity and photosensitivity, Brinciotti et al (16) noted a male preponderance for those with pattern sensitivity. A male preponderance has been documented consistently in video‐game epilepsy; nearly three‐fourths of patients in this subgroup of visually induced seizures are males (28,29,31). Although this has been attributed to a greater number of boys than girls playing video games (28,32), a survey of American school children by Funk (33) found that although girls were less involved in arcade play, a majority of them regularly played home video games.…”

Section: Discussionmentioning

confidence: 99%

Pattern‐sensitive Epilepsy: Electroclinical Characteristics, Natural History, and Delineation of the Epileptic Syndrome

Radhakrishnan¹,

Louis²,

Johnson³

et al. 2005

Epilepsia

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Purpose: To elucidate the electroclinical features and long-term outcome of patients with pattern-sensitive epilepsy. Methods: We reviewed the clinical and electroencephalo-graphic (EEG) findings of 73 (43 female and 30 male) patients in whom pattern-sensitive epilepsy was diagnosed at Mayo Clinic (Rochester, Minnesota, U.S.A.) from 1950 through 1999. We contacted patients and their relatives by letter or telephone to obtain the latest seizure and quality-of-life outcomes. Results: The median age at onset of seizures was 12.8 years (range, 0.6-32.9 years). Most patients had absence, myoclonic, or generalized tonic-clonic seizures. Interictal epileptiform discharges in the EEG were detected in 61 (83.6%) patients and were generalized in 54 (74%). Paroxysmal epileptiform discharges in the EEG elicited with standard patterns were all generalized in two thirds of patients but were restricted to the posterior head region in one-third. Eight (11%) patients did not exhibit photosen-sitivity. Television was the most common precipitant [30 patients (41%)]. Twenty-nine patients gave a clear history of one or more seizures precipitated while viewing environmental patterns such as window screens, garments, tablecloths, and ceiling tiles; the rest of the patients admitted that they preferred to avoid looking at patterned objects because these objects made them uncomfortable. The electroclinical features suggested juvenile myoclonic epilepsy in 14 patients, progressive myoclonus epilepsy in three, progressive familial cerebellar ataxia with myoclonus in two, and severe myoclonic epilepsy of infancy in one. During a median follow-up period of 15.7 years, 25 (45.5%) of 55 patients who were followed up for ≥5 years achieved complete seizure remission. The median age at remission was 24.4 years. The absence of progressive neurologic disease was correlated significantly with remission; a family history of seizures showed a trend in favor of remission. More than two thirds of the patients did not consider the seizures an impediment to their family life or to educational and occupational achievements. Conclusions: Although pattern sensitivity as a trait occurs in various epileptic syndromes, pattern-sensitive epilepsy is a readily distinguishable subtype of the visually provoked reflex epilepsies. In our opinion, the location and extent of the excitable region or regions within the visual cortex concerned with different attributes of visual function dictate susceptibility to a specific trigger (intermittent light, pattern, or color) or closely related multiple triggers and the resultant electroclinical phenomenon.

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“…According to previous studies on video game-induced seizures and TV-induced seizures, photosensitivity, pattern sensitivity, chromatic sensitivity and stimulus frequency were emphasized. 12,14,15,19 In this study, although all patients had seizures while playing MMORPGs, two patient also experienced seizure while playing card games or Chinese chess. No patient had a photoparoxysmal response to intermittent photic stimulation.…”

Section: Discussionmentioning

confidence: 73%

“…Studies of video game-induced seizures always concluded video game-induced epilepsy was a homogenous syndrome with an easily demonstrable photosensitivity on intermittent photic stimulation. 12,14,15 However, the cases of epileptic seizures associated with MMORPGs have not been reported in the literature.…”

Section: Introductionmentioning

confidence: 94%

Massively Multiplayer Online Role-Playing Game-Induced Seizures: ANeglected Health Problem in Internet Addiction

Chuang

2006

CyberPsychology & Behavior

137

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As the Internet has become rapidly and widely integrated into society, Internet addiction has become a growing psychosocial problem. However, epileptic seizure, another out-of-the-ordinary health problem, is often neglected in this regard. Ten patients who experienced epileptic seizures while playing the newest genre of electronic games -- Massively Multiplayer Online Role-Playing Games (MMORPGs) -- were investigated. Patients were predominantly male young adults, and most of the events were generalized tonic-clonic seizures, myoclonic seizures, and absences. These patients should be categorized into idiopathic generalized epilepsies. Even though photosensitivity was an important factor, behavioral and higher mental activities also seemed to be significant seizure precipitants. Results demonstrated that MMORPG-induced seizures were not analogous to the ordinary video game-induced seizures. Significantly, an epileptic seizure warning did not always appear on the websites of MMORPGs and instructions for the software. While the prevalence of MMORPG-induced seizures remains unknown, it may exceed our expectations and impact our society. Not only for clinical neurologists but also for the primary physicians, educators, sociologists, and global online game publishers, there should be an awareness of this special form of reflex seizures in order to provide an appropriate health warning to MMORPG players.

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Mechanisms of Video‐Game Epilepsy

Cited by 29 publications

References 6 publications

Human lateral geniculate nucleus and visual cortex respond to screen flicker

Human lateral geniculate nucleus and visual cortex respond to screen flicker

Pattern‐sensitive Epilepsy: Electroclinical Characteristics, Natural History, and Delineation of the Epileptic Syndrome

Massively Multiplayer Online Role-Playing Game-Induced Seizures: ANeglected Health Problem in Internet Addiction

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