Mah-jong epilepsy: a new reflex epilepsy

[Bernard]

Apparently, playing this thinking game, which can require intense concentration, can induce seizures:

Flickering light and color patterns, reading, language, movement, decision making, eating, tapping and touching, hot water immersion and auditory stimulation can induce seizures in some patients. This is known as "reflex epilepsy". The mechanism of reflex epilepsy is not clear. Recently, we cared for 12 patients (11 men and 1 woman, age 41-74 years; mean age = 63.1 years) whose seizures were induced by playing mah-jong, with mean age at seizure onset of 48.7 years. Nine of the 12 patients had seizures exclusively while playing mah-jong.

Mah-jong epilepsy: a new reflex epilepsy

The traditional Chinese game of mahjong can spark epileptic fits in susceptible people, and the only cure is to give it up, according to new research released in a Hong Kong medical journal Thursday.

A study released in the Hong Kong Medical Journal detailed the cases of 23 adult men, three in Hong Kong and 20 in Taiwan, who suffered fits brought on by playing the game of skill.

In some of the cases, drug treatment proved ineffective in stopping the seizures, which only ended after the players gave up the game.

"Mahjong is a cognitively demanding game involving substantial higher mental processing and outputs," a statement from the journal said.

It added that the game could spark "decision-making epilepsy," which can also be triggered by playing chess and card games, as well as complex board games.

Mahjong can spark epilepsy: study

This seems counter-intuitive to the brain boosting techniques that are often mentioned for maintaining or improving cognitive function. Or perhaps its akin to blowing a fuse when concentrating too hard?

[POSITIVEPERSON]

Thats so interesting, my mom and her friends had a weekly game of mah jong . I use to play with my girlfriends when I was little girl . We were playing grown ups . lol it never
bothered me. Everyone is different!!!

Riva

[brain]

Bernard:

Yup - it's true, I had to sell some of the
computerized games for that reason!



I finally found some that did not provoke
seizures. It doesn't happen right away,
but after you play for awhile, it'll get to
ya! Trust me, it will!

It's almost unfair!

[Bernard]

I was reading the Houston Chronicle's online reference to the this story and found a message in the comments section referencing subliminal distraction as a possible source for these seizures.

A new study shows that subconscious signals interfere with concentration, causing people to become easily distracted and falter on even the simplest of tasks.

When people concentrate, they focus on the task at hand and filter out information irrelevant to what they are doing. A new report, however, published in this week's Science, says that sometimes unrelated info slips through, even if it is not consciously processed. "Our results contradict the general view," says lead author Yoshiaki Tsushima, a graduate student in psychology at Boston University.

Subliminal Messages Drive the Mind to Distraction

Note that article is from Dec. 2006. I was able to find a few references to subliminal distraction on Science's web site:

Physiological Limits for "Subliminal" Perception (original 1960 study?)

Invisible Distraction (this is the article referenced above)

and from a site that seems a bit less scientifically rigorous:

Subliminal Distraction arises from normal features of physiology taught in first-semester college psychology. Two of those features form a "conflict in the physiology of sight."

You can successfully ignore distracting movement in peripheral vision but you can't stop "subliminally seeing" it. There are no "off switches" for the sensor cells on the rods and cones in your retina. If stimulus reaches them neural impulses go to your brain no matter what you are doing.

When you learn to ignore distracting movement in peripheral vision, the subliminal functioning of the reflex system prevents you becoming aware of your brain's continued efforts to warn you of threat-movement.

Those neural impulses and your brain's efforts to form a startle and vision reflex are a Subliminal Distraction.

When you create the "special circumstances" so that the startle is attempted many times each hour, for several hours daily, and for many days, the subliminal appreciation of threat eventually colors thought and reason.

Subliminal Distraction

I don't know how well this phenomenon fits as the root cause for the "Mahjong seizure", but is seems plausible that it plays a part.

[brain]

Bernard:

I don't have a problem playing the game itself
as long it's on the table.

I think the original post you posted is in reference
to the COMPUTERIZED version. Just like video games.
There are other games like the ADVANCED TYPE of
the Atari's:
PacMan
Centipede
Space Invaders
Asteriods
and so on

I had to get rid of them and just stick with the
original Atari Mode that wasn't seizure provoking.

IT IS THE SPECIAL GRAPHICS of those Computerized
Video for Computers that will effect the individual
and one does not have to have Epilepsy. It even
bothered my former neighbor's son (he doesn't have
it), and he had to get rid of the Advanced Games
above as well and others (including X-Box Games).

Just as those Macromedia Flash can provoke seizures
online - same thing.

Some games after your "thinking process is in gear"
and those lingering effects - it will trigger seizures,
slow going - but it will trigger.

HOYLE probably has the best Game Board Game
Productions for the Game Lovers - as they give
YOU more control of the graphic effects and even
the music and background control as well.

(HOYLE is the SAME producer of those who makes
playing cards for generations)

So that's ONE TIP I can give you right there that
I've learned the HARD WAY that I could share.

[Bernard]

No, the articles about Mahjong epilepsy are referring to the table game with four players - not the tile matching computer solitaire game.

[POSITIVEPERSON]

And I am sure it as intenese as any high stakes poker game. Not like my moms game
with her friends where they played for peanuts.

Riva

ps: mah jong can be played with 4 pple or a fifth who is better one round a player the next, just read the complete article,yikes 11 hrs of playing....... that is super intense

[brain]

Oh dang - I need Expresso with IV and
re-read the article AGAIN!

With EYES WIDE OPENED!

[joan]

wow, yes it does sound like my kids. Naturally, its not understood. grr....

I know my kids are in good shape now but my fear, is for the future. When we normally start losing skills. I fear they will decline way earier than others and Im not sure to what extent. Ive decided to live to 150 : ) Also for the record, both kids not photosensitive and both have no issues with playing video games,,, so far : )

joan*

Science 15 December 2006:
Vol. 314. no. 5806, p. 1653
DOI: 10.1126/science.314.5806.1653l
Prev | Table of Contents | Next

This Week in Science
An invisible, subthreshold stimulus can influence visual processing and behavior. However, subthreshold stimulus processing in the brain is not understood. Tsushima et al. (p. 1786; see the Perspective by Stoerig) discovered that when a subthreshold stimulus is task-irrelevant, it activates the visual cortex more than suprathreshold stimuli and severely disrupts task performance.

[joan]

The plot thickens... although games dont effect them. It does seem this describes them to a degree. I really have tothink about this. Thank you*

http://emedicine.medscape.com/article/1187259-overview

Seizures induced by thinking: Cognitive processes have been reported to induce seizures in susceptible persons. Initially described during the performance of mathematical calculations, the seizures also may be produced by processing spatial information or by other forms of decision making. Reflex seizures have been described as a result of playing chess or checkers, also likely due to the cognitive processes involved in playing these games.

http://www.orpha.net//consor/cgi-bin...=GB&Expert=310

Reflex epilepsies (RE) are rare epileptic syndromes with seizures induced by specific triggering factors (either by visual, auditory, somato-sensitive or somato-motor stimulation, or by higher cortical function activities). Their prevalence varies from 1/3 000 to 1/700 for the most frequent forms (photosensitive epilepsies). Spontaneous seizures may also occur. "Reflex seizures'' can be classified into a simple "pure'' reflex epilepsy and a complex group. The former comprises seizure triggered by simple sensory stimuli or by movements (photosensitive epilepsies). The latter are triggered by complex mental and emotional processes (verbal and non-verbal epilepsies). RE may also be classified into epilepsies that are primary or idiopathic (a genetic basis is likely) and epilepsies that are secondary or symptomatic (with an acquired basis). Reflex epilepsies are generally considered as idiopathic. Primary RE frequently have a family history, an age of onset in early life, a benign prognosis and good response to medication (sodium valproate, lamictal), and an electroencephalogram (EEG) with a variable presentation but an almost invariable normality of background activity. Electroencephalographic seizures expression may be partial or generalized. Secondary RE occur later, frequently in patients with an associated neurologic and non epileptic impairment. There is sometimes less stereotypy in clinical expression, a poorer response to drugs for focal seizures triggered by specific stimuli (carbamazepine, phenytoin), and frequently an abnormal interictal EEG background. *Authors: Drs G. Rudolf, MP Valenti, Prof. E. Hirsch (March 2004)*.

It does also mention glutens being an issue, which I think is my son. So far I can only find info from outside the United States.... grrr....