Video-game epilepsy: A European study

With the introduction of Nintendo video-games on a large scale, reports of children having seizures while playing suggested a possible specific, provo cative factor. Although 50% of the photosensitive patients are also sensiti ve to a 50-1-12 television, nonphotosensitive patients with a history of vi deogame seizures were described as well. The question arises whether this i s a mere coincidence, provoked by fatigue and stress, is related to the rea ction to the television screen itself, or depends on the movement and color of the pictures of this specific game. A European study was performed in four countries and five sites. All patien ts were selected because of a history of television, video- or computer-gam e seizures, with a history of sunlight-, discotheque-, or black and white p attern-evoked seizures, or were already known to be sensitive to intermitte nt photic stimulation. A total of 387 patients were investigated; 220 (75%) were female and 214 (55%) of those were <18 years of age. After a routine examination, intermittent photic, pattern, and television s timulation were performed in a standardized way. The patients were investig ated with Super Mario World and a standard relatively nonprovocative TV pro gram, both on a 50- and 100-Hz television. Regardless of the distance, Supe r Mario World proved to be more provocative than the standard program (Wilc oxon, p < 0.05), Eighty-five percent showed epi leptiform discharges evoked by intermittent photic stimulation. Forty-five percent of patients were 50 -Hz television sensitive and 26% were 100-Hz television sensitive. Pattern sensitivity was found in 28% of patients. The patients, referred because of a television, video- or computer-game sei zure, were significantly more sensitive to pattern and to the 50-Hz televis ion (chi square, p < 0.001). More patients are sensitive when playing Super Mario, compared with the standard program (Wilcoxon, p = 0.001) and more s ensitive with playing versus viewing (p = 0.016). Of the patients who were referred because of seizures in front of the telev ision, or evoked by a video- or computer game, 14% proved not to be photose nsitive. Although no difference in age or use of medication was found, twic e as many men were found in this nonphotosensitive group.