Avoiding 'Pokemon' Seizures From TV, Video Games

Rapidly Flashing Lights May Trigger Rare Seizures, Experts Report

From the WebMD Archives

Sept. 20, 2005 -- The Epilepsy Foundation has issued new guidelines to help avoid rare cases of seizures triggered by flickering lights from TV and video games.

The guidelines are particularly important for people who are sensitive to light, but "the suggestions are valid for everybody," Giuseppe Erba, MD, tells WebMD.

Erba is a professor of neurology and pediatrics at the University of Rochester. He helped write the guidelines, which include:

TV Viewing

  • Watch TV in a well-lit room.
  • Reduce the screen's brightness.
  • Keep as far back from the screen as possible.
  • Use the remote control to change channels.
  • Avoid watching TV for long periods of time.
  • Wear polarized sunglasses while viewing TV to reduce the glare.

Video Games

  • Sit at least 2 feet away from the screen in a well-lit room.
  • Reduce the screen's brightness.
  • Don't let children play video games if they are tired.
  • Take frequent breaks and look away from the screen every once in a while.
  • Cover one eye while playing and regularly change which eye is covered.
  • Turn the game off if strange or unusual feelings develop.

Computer Screens

  • Use a flicker-free monitor (LCD display or flat screen).
  • Use a monitor glare guard.
  • Wear nonglare glasses to reduce glare from the screen.
  • Take frequent breaks from tasks involving the computer.

Strong Environmental Lights

  • Cover one eye (either one) with one hand until the stimulus is over.
  • Closing both eyes or turning your eyes away from the stimulus will not be effective.

TV, Video Games Don't Cause Epilepsy

Video games and TV don't cause epilepsy, Erba and the Epilepsy Foundation stress.

"It's quite clear that the exposure to video games does not make you become an epileptic," says Erba.

There are various factors, even in people who are predisposed to seizures, that contribute to the seizure activity triggered by lights. The Epilepsy Foundation also stresses that the frequency or the speed of flashing lights most likely to cause seizures can vary from person to person.

"It's not clear what percentage of people has this particular vulnerability," he says.

Past studies of healthy children have shown that 4% to 9% of the general public is sensitive to light, says Erba. An even smaller number is highly sensitive to light, and a fraction of that group may have seizures from rapidly flashing lights or fast-changing colors on a screen.

According to the Epilepsy Foundation, photosensitivity epilepsy is more common in children and adolescents, especially those with generalized seizures, and becomes less frequent with age.

"The risk of having a seizure if you are sensitive is only one out of 17,000 viewers if you are young," says Erba. "If you are older, it's even less. It's one out of 90,000," he says.

Those numbers came from studies done in England a decade ago, Erba notes. "It doesn't reflect today's situation, with all these new video games that are coming on the market," he says.

Expert's Advice for Parents

An electroencephalogram (EEG) test is needed to check for light sensitivity, says Erba. EEG tests can monitor the electrical activity of the brain during light stimulation; an abnormal response can indicate light sensitivity.

Should parents ask for that test for kids who play video games?

Erba says it might be worth consulting a doctor about that if kids are "very, very engaged in video game playing and so forth" and if a family member is known to be sensitive to light or has certain types of epilepsy that are more likely to be associated with the problem.

Under those circumstances, Erba says his suggestion for parents is to talk to a doctor "and figure out whether it might be worthwhile to get [the child] to have an EEG."

If the child is not sensitive, "there is no danger. But if they are sensitive, they should probably take precautions," says Erba.

"To have seizures, you have to be sensitive and you have to be exposed to a combination of factors that will bring you over the brink," he says.

American Advantage?

The same issue has come up in the U.K. and Japan, says Erba. In the journal Epilepsia, Erba and colleagues note nearly 700 hospital admissions in Japan -- mostly for seizures -- after a December 1997 episode of a Pokemon cartoon.

America's TV system has a slightly higher frequency than those in the U.K. and Japan. That offers "a little bit" of protection against the effects of rapidly flickering lights but not against quickly changing colors, says Erba.

He adds that the new flat-screen TVs have "no problem" with flickering but have much brighter colors.

"Video games and TV programs should not have flashes higher than three per second," says Erba. "You can have perfectly attractive programs flickering at three per second. You don't have to go to nine or 10 per second."

Video Game Group Responds

WebMD emailed the Epilepsy Foundation's recommendations and Erba's report in Epilepsia to Jason Della Rocca, the executive director of the International Game Developers Association.

In an email, Della Rocca says this is the first time he has seen this particular research.

"Video game[s] form an important part of the media and entertainment mix of millions people on a daily basis. And, I'd say that the maxim of all things in moderation will always apply," writes Della Rocca.

"Ironically, gamers -- young and old -- usually have no shortage of 'encouragement' to maintain that balance," writes Della Rocca.

Show Sources

SOURCES: News release, Epilepsy Foundation. Giuseppe Erba, MD, professor of neurology and pediatrics, University of Rochester. Harding, G. Epilepsia, Sept. 2005; vol 46: pp 1423-1425. Jason Della Rocca, executive director, International Game Developers Association.
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