Epilepsy Myths - Northeast Regional Epilepsy Group

Enrique Feoli MD
North East Regional Epilepsy group
“Sacred Disease”
The disease with the thousand names
Babylon, people that suffer from epilepsy
were felt to possessed by a demon.
Asia and China, 8th Century medical
manuscript refer to “Xian” falling sickness.
India, has one of the oldest medical
systems ever recorded. “Apasmara”, was
the word use to describe epilepsy.
“Sacred Disease”
The disease with the thousand names
Roman Empire, the blood or liver of
gladiators killed in the Roman games
should be consumed as a remedy for
Seizures Myths
• If the person who sees the spasm, first
urinates in his shoe, tips it back and forth
and then gives the patient the urine to
drink, the seizure will stop immediately.
Antonius Guainerius, 1440
Seizures Myths
• As the convulsions stem from the spinal
cord, pour warm water, 28°C, over the
patient's back.
Before 1920
Seizures Myths
morbus scelestis (Lat.: the accursed
disease, the wicked disease) People with
epilepsy were often regarded to have been
deserted or punished by God.
Seizures Myths
• Cut a black pigeon or a black hen through
the middle, put it onto the head of the child
with epilepsy and then give it to a dog to
(Folk tradition, source unknown)
15th Century
• Image taken from
the first medical
Haniyye", written
in Ottoman
language by the
Turkish surgeon
• From the Ancient
World to the Middle
cauterizations were
also used in the
treatment of
• Raphael
Transfiguration of
 Hippocrates recognized that epilepsy
as an organic process of the brain.
 J.H. Jackson 19th century, formulated
the modern definition of epilepsy
“ A occasional excessive and
disorderly discharge of nerve tissue”
Current Times
Haiti; epilepsy is still considered to be the
result of possession by “loas”
Africa; some tribes believe that epilepsy is
1999 Hungary 415 patients 65% consulted
with religious figures during the course of
their disease.
Seizures: transient occurrence of signs
and symptoms due to and abnormal
excessive neuronal activity in the brain.
Epilepsy: is a disorder of the brain
characterized by two or more unprovoked
Seizure Disorder
Coughing Disorder; Asthma
Diarrhea Disorder; gastroenteritis
Supplement for seizures
AES meeting in New Orleans, University
of California at San Francisco showed
 187 patients
 56 % used alternative medicines
 68% Let their physicians know
 15 % took something that could make
seizures worse
 15% took something that could interfere
with AED’s
Supplement for seizures
Evening primrose
St John’s Wort
May exacerbate Sz
Induce liver Metabolism
Swallowing the Tongue
“The myth that someone having a seizure
may swallow his tongue is physically
impossible. Because of this myth, people
tend to do more harm than good by trying
to force something in the mouth of the
person having a seizure to hold his tongue
Photic Stimulation, video Games
and Epilepsy
 1885 Gowers described Abnormal EEG in a girl
who had seizures going into bright sunshine.
Seizures due to TV content
 1980’s Captain Powers, induce a seizure in a
young man
 1993 an advertisement for “Golden Wonder, Pot
Noodle” in UK induced 3 seizures in the first
Pokemon Incident
An unplanned Experiment in Nature
 Pokemon incident in Japan
 Most Dramatic
 December 16, 1997.
 A rocket launch sequence of flashing red and
blue lights changing at 12.5 sec for 4 sec. was
shown on Tokyo TV.
 685 children went to the hospital
 560 of this children had seizures
 Rest had migraines, nausea, motion sickness.
Pokemon Incident
An unplanned Experiment in Nature
Warning Cover one eye
Pokemon Incident
75 % of the children did not have epilepsy
Given that 7 million children were watching the
program, this suggests that 1 in 10,000 had a
seizure in response to photic stimulation.
Only 24% who had a seizure during the cartoon
had previously experienced a seizure
Photic- and Pattern-induced Seizures: A Review for the Epilepsy Foundation of
America Working Group*Robert S. Fisher, †Graham Harding, ‡Giuseppe Erba, §Gregory L.
Barkley, and Arnold Wilkins Epilepsia
Volume 46 Page 1426 - September 2005
1167.2005.31405.xVolume 46 Issue 9
Summary: Purpose: This report summarizes background material presented to a
consensus conference on visually provoked seizures, convened by the Epilepsy
Foundation of America.
Methods: A comprehensive review of literature was performed.
Results: Photosensitivity, an abnormal EEG response to light or pattern stimulation,
occurs in 0.3–3% of the population. The estimated prevalence of seizures from light
stimuli is 1 per 10,000, or 1 per 4,000 individuals age 5–24 years. People with
epilepsy have a 2–14% chance of having seizures precipitated by light or pattern. In
the Pokemon cartoon incident in Japan, 685 children visited a hospital in reaction to
red–blue flashes on broadcast television (TV). Only 24% who had a seizure during
the cartoon had previously experienced a seizure. Photic or pattern stimulation can
provoke seizures in predisposed individuals, but such stimulation is not known to
increase the chance of subsequent epilepsy. Intensities of 0.2–1.5 million
candlepower are in the range to trigger seizures. Frequencies of 15–25 Hz are most
provocative, but the range is 1–65 Hz. Light–dark borders can induce patternsensitive seizures, and red color also is a factor. Seizures can be provoked by certain
TV shows, movie screen images, video games, natural stimuli (e.g, sun on water),
public displays, and many other sources.
Conclusions: Recommendations on reducing risk of seizures have been developed by
agencies in the United Kingdom, Japan, and the International Telecommunications
Union, affiliated with the United Nations. The Epilepsy Foundation of America has
developed a consensus of medical experts and scientists on this subject, reported in
an accompanying work.
Photic Stimulation, video Games
and Epilepsy
Photic Induced Seizures: a seizure
provoked by visual stimulation.
Photoparoxysmal response, an abnormal
EEG response to light or pattern,
consisting of spikes, spike waves or slow
waves, should not be confined to the
occipital region, should not be confused
with photic driving.
Television US vs UK
 USA and Japan (NTSC) TV screens scan at
 Europe (PAL standard, phase alternating line)
scans at 50 HZ
 Stimulation at 50Hz produces PPR in 49% of
photosensitive patients
 Stimulation at 60Hz produces PPR in 15% of
Photic Stimulation, video Games
and Epilepsy
Visual Acuity
Ambient light
Brightness of the screen
Among others
Photic Stimulation, video Games
and Epilepsy
Video Display Units
Should be less likely than TV to provoke
Tend to be smaller
Less bright
Refresh at 70Hz
Video Games
 1981 The Lancet “space invader epilepsy”
 1981 Jeavons (UK) Seizure by a hand held
video game.
 1983 Dahlquist (USA) first US video game sz
 1991 Nintendo starts putting warning on games.
 1992 UK a child died following a seizure
induced by video game.
 1994 Ferrie, 35 cases, coined the term video
game epilepsy
Video Games
Ricci and Vigevano Study
European Video-Game study
Video Games
Video Game Epilepsy
Photic Induced Epilepsy
Video Games
Some patients with a predisposition
towards epilepsy might have their first
seizure while playing a video game, but
this does not mean that the video game
cased epilepsy.
Video Games
Screening devices are difficult for video
Video Games posses a minor risk for
patients with no known photosensitivity.
Video Games
Can Individuals with epilepsy, but with no known
ABN EEF induce by pthotic stimulation safely
play a video game?
 Millet and colleagues 1999
 212 patients, with Epilepsy no EEG photic or
pattern sensitivity
 Randomly assigned to a video game or leisure
 Then crossover
 End point clinical seizure
Video Games
25 seizures 13 during video game, 12 during
other activities.
Patients with Epilepsy with no know
photoparoxysmal sensitivity MAY
SAFELY play video games.
View TV from > 8 feet
View in a well-lit room, with a small lamp
on top of the TV set.
Do Not approach the TV to switch
Cover one eye if it is necessary to go near
the TV
Wear polarized glasses on sunny days to
reduce flickering reflection from water.
Video Game Recommendations
 While playing video games the screen should be
less than 12 inches or the patient should sit
more than 4 times the diagonal diameter from
the screen.
 Play for more than 1 hour should be avoided,
and sleep should be maintained.
 People with hx or family history of
photosensitivity should have an EEG
examination with photic stimulation before
playing video games.
Recreational Activity and Epilepsy
“Persons with epilepsy are often excluded or
discouraged from participation is sports
and recreational activities because of fear
of what might occur during the activity”
Athletics and Epilepsy
It is an Individual
Exercise provoked seizures
True or False
The data is limited, but there is no prove that
sports participation provokes seizure
recurrence. (Sports Medicine 1999;10:919)