URBAN MYTH and EPILEPSY

1. URBAN MYTH and EPILEPSY Enrique Feoli MD North East Regional Epilepsy group

2. “Sacred Disease”The disease with the thousand names History • 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.

3. “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 epilepsy.

4. 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

5. Seizures Myths • As the convulsions stem from the spinal cord, pour warm water, 28°C, over the patient's back. Before 1920

6. 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.

7. 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 eat. (Folk tradition, source unknown)

8. Image taken from the first medical textbook "Cerrahiyyet'ül Haniyye", written in Ottoman language by the Turkish surgeon Serafettin Sabuncuoglu. From the Ancient World to the Middle Ages, cauterizations were also used in the treatment of epilepsy. 15th Century

9. Raphael (1483-1530) Transfiguration of Christ

10. Epilepsy • 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”

11. Epilepsy Current Times • Haiti; epilepsy is still considered to be the result of possession by “loas” • Africa; some tribes believe that epilepsy is contagious. • 1999 Hungary 415 patients 65% consulted with religious figures during the course of their disease.

12. Epilepsy • 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 seizures.

13. Epilepsy Seizure Disorder Coughing Disorder; Asthma Diarrhea Disorder; gastroenteritis

14. Supplement for seizures AES meeting in New Orleans, University of California at San Francisco showed that; • 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

15. Supplement for seizures Ginseng Gingko May exacerbate Sz Evening primrose Gingko St John’s Wort Induce liver Metabolism Echinacea Garlique

16. 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 down”

17. 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 showing.

18. 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.

19. Pokemon Incident An unplanned Experiment in Nature Warning Cover one eye pokemon.flv

20. 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

21. 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 EpilepsiaVolume 46 Page 1426  - September 20051167.2005.31405.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 pattern-sensitive 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.

22. 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.

23. Television US vs UK • USA and Japan (NTSC) TV screens scan at 60HZ • 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 them.

24. Photic Stimulation, video Games and Epilepsy OTHER FACTORS • Visual Acuity • Ambient light • Content • Brightness of the screen • Among others

25. Photic Stimulation, video Games and Epilepsy Video Display Units • Should be less likely than TV to provoke seizures • Tend to be smaller • Less bright • Refresh at 70Hz

26. 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 report • 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

27. Video Games Ricci and Vigevano Study European Video-Game study

28. Video GamesMisnomers Video Game Epilepsy Photic Induced Epilepsy

29. 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.

30. Video Games Screening devices are difficult for video games. Video Games posses a minor risk for patients with no known photosensitivity.

31. 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 activity. • Then crossover • End point clinical seizure

32. Video Games 25 seizures 13 during video game, 12 during other activities. ANSWER IS Patients with Epilepsy with no know photoparoxysmal sensitivity MAY SAFELY play video games.

35. TV RECOMMENDATIONS • 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 channels. • Cover one eye if it is necessary to go near the TV • Wear polarized glasses on sunny days to reduce flickering reflection from water.

36. 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.

37. 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”

38. It is an Individual decision Athletics and Epilepsy

39. Exercise provoked seizures True or False The data is limited, but there is no prove that sports participation provokes seizure recurrence. (Sports Medicine 1999;10:9-19)