‘Video game-induced seizures’ (VGS) is preferable than ‘video game epilepsy’ because this is not a syndrome.

There is clearly heterogeneity in seizure types, seizure syndromes, precipitating and facilitating factors, and underlying mechanisms.

Prevalence
One of the most common forms of photosensitive epilepsy.

Age at onset
7 to 19 years (87% of patients).

Sex
Males predominate probably because more males than females play video games.

Clinical manifestations
2/3 suffer from generalized seizures and the majority of them suffer from various syndromes of idiopathic generalized epilepsy. The remaining 1/3 have occipital seizures with or without photosensitivity. Other types of focal seizures are exceptional.

Precipitating factors
Games using an interlaced video monitor, small hand-held liquid crystal displays, and non-interlaced 70-Hz arcade games.

There are many mechanisms by which video games may induce seizures. These are (1) photosensitivity; (2) pattern sensitivity; (3) emotional and cognitive excitation (excitement or frustration); and (4) proprioceptive stimulation (movement/praxis).

Fatigue, sleep deprivation, and prolonged playing are facilitating factors.

Only 70% of patients with well-documented VGS are photosensitive on IPS. In the other one third of patients appropriate IPS does not evoke a photoparoxysmal response (PPR) and these belong to:

• Idiopathic generalized epilepsy without photosensitivity. These patients have various forms of IGE with spontaneous seizures who also have VGS. Cognitive and emotional factors seem crucial provocative agents.
• Idiopathic occipital epilepsy: These patients have typical focal occipital seizures with ictal visual hallucinations, visual deficits or both. EEG shows spontaneous occipital spikes without PPR.
• Low-threshold to seizures: These are young adults rather than teenagers. Their EEG is normal in all respects. VGS occur when a number of seizure precipitating and facilitating factors cluster together at the time of the incidence. These are sleep deprivation, thirst, hunger, mental and emotional heightening, and prolonged playing of exciting and provocative video games. In such patients it is unlikely that one of these provocative factors on its own is sufficient to initiate seizures, but that a number of them together are.
• Pure pattern epilepsy without photosensitivity: This may be extremely rare or does not exist.

Management options*
Avoidance of precipitating and facilitating factors.

A thorough clinical and EEG evaluation is needed to identify likely precipitating factors and enable individual guidelines to be offered. VGS should not be equated with photosensitivity alone. 1/3 of patients with VGS are not photosensitive. The practical implication of this is that not all patients who have seizures while playing video games will be helped by the advice recommended for photosensitive patients.

*Expert opinion, please check FDA-approved indications and prescribing information

This page was adapted from:

The educational kit on epilepsies
The epileptic syndromes
By C. P. Panayiotopoulos

Originally published by MEDICINAE
21 Cave Street, Oxford OX4 1BA
First published 2006 and reprinted in 2007