Photosensitive and Nonphotosensitive Electronic Screen Game‐Induced Seizures

Abstract

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...

Enhanced frontocentral EEG connectivity in photosensitive generalized epilepsies: A partial directed coherence study

“…Neurophysiologic evaluations such as transcranial magnetic stimulation (TMS) (Siniatchkin et al., 2007; Shepherd & Siniatchkin, 2009), evoked potentials (Guerrini et al., 1998; Porciatti et al., 2000), or fMRI (Chiappa et al., 1999; Moeller et al., 2009a,b) have indicated the increased involvement of the primary recipient occipital cortices of light stimuli in PS patients. However, most of these works (and other hemodynamic and neurophysiologic studies) found that extraoccipital cortices and subcortical structures are also involved in the hyperexcitability mechanism (Kapucu et al., 1996; Chiappa et al., 1999; Inoue et al., 1999; Holmes et al., 2010). Frontal or premotor cortices are certainly involved in the direct generation of spike and wave discharges, including those evoked by PS in patients with generalized epilepsies, as has been directly demonstrated by inspectional EEG analyses (Niedermeyer, 1996; Kasteleijn‐NolstTrenité, 1998) or quantitative methods (Gotman, 1981; Takasaka et al., 1989; Visani et al., 2010).…”

Optical coherence tomography parameters in patients with photosensitive juvenile myoclonic epilepsy

“…We used the lamp with circular reflector that delivers flashes with an intensity of 0.70 Joule which at 30 cm from the nasion of the patient. IPS was performed with frequencies of 1,2,4,8,10,12,15,18,20,25,40,50, and 60 flashes/ s, and 0.5 and 70 Hz filters were used. Each frequency was performed with an interval of at least 7 s between each frequency, and each application was continued for 10 s, during which the eye was kept open in the first five seconds and closed in the last five seconds.…”

“…There are numerous studies suggesting that PPR is related with extreme excitability and reactivity in the visual cortex [12,13]. Moreover, it has been revealed in several studies that during the PPR, functional changes and changes in the blood stream occur in the supplementary motor area (SMA), the perisylvian area and medial temporal areas, besides the occipital cortex [14][15][16]. Strigaro et al documented a defective inhibition in the visual system of photosensitive patients with IGE, using a new VEP technique (Faired pulse flash -VEP) [17].…”

Photic‐ and Pattern‐induced Seizures: A Review for the Epilepsy Foundation of America Working Group

“…Their findings were consistent with the idea that normal synchronized activity of large numbers of cells brought about by repetitive visual stimulation (evidenced by the harmonic gamma activity) results in a failure of inhibitory processes and culminates in the pathologic synchronization of the epileptic discharge. MEG was used by Inoue and associates (89) to investigate localization of electronic screen game-induced spikes. Patients who were photosensitive had MEG-documented posterior predominance of source dipoles in patients who had spikes during electronic screen games (89), but additional dipoles were localized to the supplementary motor area, perisylvian region, and medial temporal lobe.…”

“…MEG was used by Inoue and associates (89) to investigate localization of electronic screen game-induced spikes. Patients who were photosensitive had MEG-documented posterior predominance of source dipoles in patients who had spikes during electronic screen games (89), but additional dipoles were localized to the supplementary motor area, perisylvian region, and medial temporal lobe.…”