I received a phone call from a patient whose 11 year old son had suffered a seizure, which actually occurred while he was playing a video game.
It is hugely coincidental that I had just gone to a conference the day before (to get my required CME hours) where we discussed “First Seizures in Otherwise Healthy Children”. A seizure, as defined from my lecture notes is “ the clinical manifestation of an abnormal excessive excitation and synchronization of a population of cortical neurons”. In layman’s terms "it is the abnormal and excessive electrical activity within the brain that results in a change in movement, attention or level of awareness”.
About 3% of children under the age of 15 years will have a seizure. The majority of these will be related to having a fever. (We have discussed febrile seizures before.) When reviewing data I also found that even the Nintendo website states that 1 /4,000 people may have a seizure brought on by playing video games. It is more common for children and teens to have a seizure due to a photosensitivity reaction which occurs while playing video games.
The first question that people as is what is the risk of having another seizure? The risk of having a second seizure is reported to be about 40 – 50% and several authors report that the recurrence rate after a second seizure is about 80%. In other words, more than half of the people who have a first seizure may never have another. Having a second seizure within 6 months of the first is a risk factor for additional recurrences. Having an abnormal EEG also increases the risk of having another seizure, and those patients with a normal EEG after a first seizure only have a 25% risk of recurrence.
Children who experience a seizure which is thought to be related to playing video games are not “forbidden” from playing video games but should be cautioned to take frequent breaks while playing, every 30 – 60 minutes. (This is another good reason to limit your child’s video game playing.)
It is also recommended that children not sit too closely to the TV and to use a smaller screen TV to play video games, and to have the room well lit.
The question then is this, should you treat a first seizure? There are both risks and benefits of treating with anti-epileptic drugs. Although treatment with anti-epileptic drugs does reduce the recurrence rate of another seizure by about 50%, it does not alter the long term prognosis.
In general most pediatric neurologists think that treatment of a first seizure in otherwise healthy children should be deferred until a second seizure has occurred. This will require educating both the parent and the child about the risk of another seizure, how to handle a seizure and also warnings about bathing or swimming alone. Close follow up with your pediatrician and a child neurologist is recommended.
That's your daily dose for today. We'll chat again tomorrow.
