Open letter to the BioShock creative team

BioShock Infinite logo largerCongratulations on last month’s successful launch of BioShock Infinite. The reviews are extraordinary. BioShock Infinite is said to set a new standard for what the video game experience can be. Players are moved and enthusiastic about many aspects of the game and speak effusively about their unprecedented degree of involvement with the story and characters. With all the creative energy, care, and respect for players that went into developing BioShock, though, the game–like so many others–exposes players to visuals that can cause seizures.

I examined several BioShock launch trailers and some other “footage” – a total of eight clips of a few minutes each – and assessed them using an application that identifies video sequences that can trigger seizures. Most of the material was fine, but three of the clips contained brief flashing sequences that don’t meet criteria for safe viewing. It doesn’t take more than a brief exposure to trigger seizures in those who are vulnerable.

This BioShock scene uses safe levels of flash

This BioShock scene uses safe levels of flash.

Contrary to what many gamers assume, eliminating seizure triggers doesn’t make a game boring to look at or play. Irrational Software created a visually stunning, highly engaging experience in which most of the scenes don’t pose a seizure risk. Reports of video game-induced seizures began surfacing in 1981 in newspapers and medical journals. A great deal is known about what types of images and sequences can provoke seizures.

Guidelines for seizure-free video sequences were developed in the UK more than 20 years ago. Since 1991 all television programming and commercials there are required to pass a seizure-safety test. Japan put in place a similar measure following the 1997 Pokémon broadcast that led to hundreds of seizures. In 2005 the International Telecommunication Union published recommended universal guidelines for reducing photosensitive seizures from televised material.

While all these efforts were made to reduce the risk to consumers of photosensitive seizures, video game publishers took their own action—providing printed seizure warnings. The warnings began appearing in the early ‘90s, after a few consumers filed personal injury lawsuits. Putting a seizure warning on video games has thus far provided legal cover for your industry, but offers little protection for customers.

Flash in this scene is safe, too.

Flash in this scene is safe, too.

The warnings all state that photosensitive seizures happen to “a very small percentage of people.” Seizures from flashing images are not rare, but people believe they are because that’s what the warnings say! The wording of these warnings is based on researchers’ estimates that were made decades ago, before today’s sophisticated graphics and before more recent studies that suggest that many photosensitive seizures could be going completely unnoticed. Many doctors continue to think these seizures are rare because that’s what they were taught.

If you haven’t heard many reports of seizures happening while playing BioShock, don’t assume the seizures aren’t occurring. They’re just not being identified. A person experiencing seizures is likely to lose awareness and not even realize what’s happening, or notice that a bit of time has passed that they can’t account for. Furthermore, most seizures don’t involve convulsions, and the only sign others might see could be as subtle as a short period of staring.

Whether or not a seizure is noticeable, it’s a serious event with real risks to health. It can impair health, thinking, and behavior for days afterward. Sometimes a seizure results in permanent disability.

This scene failed seizure safety guidelines.

But this screen capture from the Harding Flash and Pattern Analyzer shows that flash in the BioShock sequence shown at upper left failed seizure safety guidelines.

It’s not reasonable to expect parents to continually monitor their kids for possible signs of a seizure, particularly given that video games are played while people face a screen. So let’s turn to older teens and adults in the midst of a game, who might theoretically be more self-aware and responsible for their own well-being. Will they be vigilant for seizure symptoms such as odd sensations or altered consciousness?

Just last month in a New York Times interview your creative director Ken Levine said, “We work really hard to wear down the audience’s ability to even process. If players are immersed enough, they stop treating it as a piece of artifice and just start experiencing it.” Do you see the problem here? In this ideal game experience, how can players be expected to “immediately stop playing and consult a doctor” as the warning advises, if they develop symptoms consistent with a seizure?

With BioShock Infinite now brought to market, people are asking what your company will do next. You could easily raise the bar further for the industry by publicly committing to developing seizure-safe games. I live in the Boston area and would welcome the chance to begin a conversation about this at your headquarters in Quincy.


Lawsuits filed after games caused seizures

courtroomNo  consumer has won a product liability/personal injury case against a game manufacturer whose video game triggered seizures. Cases were either dismissed, settled, or won by the game company.

Despite their limited usefulness to consumers,  seizure warning notices do seem to provide legal protection to game publishers. And juries have a hard time awarding damages to plaintiffs with a pre-existing condition, even if plaintiffs didn’t know of their photosensitive epilepsy prior to the seizure(s) triggered by a video game.

In one case Nintendo actually conceded that its game had in fact triggered seizures, but that didn’t get in the way of the company winning the case. A judge later overturned the jury’s verdict because Nintendo had withheld critical information in contempt of court.

The cases date back to 1991, but the apparent total number of cases–ten–is pretty small.  One has to wonder what percentage of the seizures triggered by exposure to video games are ever identified as visually induced seizures.

One of the few consumers to reach a settlement is John Ledford of Alabama, whose settlement agreement bars John from discussing his own case. John has found another way to raise awareness of video game seizures. He has researched other cases and reached out to epilepsy organizations around the globe to raise their awareness of the continuing seizure hazard from video game images. John’s Facebook page contains most of the history I’ve assembled here:

Year Filed State Plaintiff(s) Game(s)/Platform/Defendant  Outcome 
1991 MI 15-year old Laura Moceri had grand mal seizure while playing. Kid Icarus (Nintendo) Lost
1993 IL Chicago boy suffered occasional seizures during many hours of game play. Nintendo Dismissed
1995 AL John Ledford had his first ever grand mal seizure while playing game at an arcade. The seizure damaged his optic nerve and caused blindness in one eye. King of the Monsters II (SNK Corp.) Settled
1998 LA 13 year-old Joey Roccaforte had clusters of violent seizures Mega Man X (Super Nintendo) Jury ruled for Nintendo; judge later vacated the decision because Nintendo withheld critical information before and during trial.
2001 LA Esther Walker, mother of 30-year old Benjamin Walker, who died from hitting his head on a table and sustaining internal injuries during a game-induced seizure. Nintendo 64 Lost
2001 LA 11 year-old Michael Martin, son of  Eric Martin, mayor of St. Martinsville, LA. Seizures that began happening during games began occurring also during sleep. Super Mario Kart (Nintendo 64) Settled personal injury claim; lost case advocating better warnings.
2001 LA 6 year –old Kynan Hebert, son of Lynette Benoit Nintendo Dismissed
2002 FL 16 year-old Dominic Zummo Star Wars Episode I: Jedi Power Battles (LucasArts Entertainment, SONY) Unknown
2007 NY While watching his brother play a game, 4 year-old boy had a seizure causing permanent injury. Spyro: Enter the Dragonfly (Vivendi, SONY Playstation 2) Last available information: attorney for plaintiff was seeking other plaintiffs for class action suit
2011 CA Navy F-18 pilot John Ryan McLaughlin injured in a grand mal seizure that causes permanent loss of flight status Oblivion: The Elder Scrolls IV (Bethesda Software), Sony Playstation 3. Still pending; no other information available.

What constitutes product liability?

In 1997 the criteria for product manufacturer’s liability for a product that has caused harm were revised by the American Law Institute, an independent body of legal experts that drafts and publishes restatements of common law in order to clarify and simplify it. Its work is used as a resource by state lawmakers, judges, and lawyers. Every state has its own laws concerning burden of proof, the awarding of damages, and the like.

The 1997 restatement of product liability law states, “a product is defective when, at the time of sale or distribution, it contains a manufacturing defect, is defective in design or is defective because of inadequate instructions or warnings.” These conditions are then defined separately:

  • A product “contains a manufacturing defect when the product departs from its intended design even though all possible care was exercised in the preparation and marketing of the product.” 
  • A product “contains a design defect when the foreseeable risks of harm posed by the product could have been reduced or avoided by the adoption of a reasonable alternative design by the seller or other distributor, or a predecessor in the commercial chain of distribution, and the omission of the reasonable alternative design renders the product not reasonably safe.” 
  • A product “is defective because of inadequate instructions or warnings when the foreseeable risks of harm posed by the product could have been reduced or avoided by the provision of reasonable instructions or warnings by the seller or other distributor, or a predecessor in the commercial chain of distribution and the omission of the instructions or warnings renders the product not reasonably safe.”

Some game companies are apparently working to make games that do not provoke seizures, but only Ubisoft has made a public commitment. As far as I can tell, most are merely reworking their warnings.


Nintendo knew about, downplayed seizure risks: BBC report

Nintendo's Mega Man X was among the four games tested by the BBC that did not meet the flashing and pattern safety guidelines used by British TV.

Nintendo’s Mega Man X was one of the four games tested by the BBC for this investigative report that did not meet  British TV seizure safety guidelines.

A BBC report on Nintendo revealed that the company knew more than 20 years ago which of its games were most likely to cause seizures–and downplayed the seizure risk to customers. A former Nintendo customer relations employee interviewed for the story said that many customers called to  complain about experiencing seizures. Because he wanted to advise customers concerned about the seizure risk, he asked the company’s R & D group for a list of the games most likely to cause seizures. 

Developers came up with a list of more than 30 games. Before the list was released to customers, he said, the company’s lawyers pared down the list to 12 – 15 titles. As customer complaints about seizures grew, Nintendo stopped releasing any seizure information about specific games. The Nintendo executive interviewed asserted that the company began making its games safer and started including seizure warnings with game instructions as soon as the problem came to their attention—in 1991.

The story, featured on the BBC’s Outrageous Fortune program in 2004, also includes an interview with photosensitive epilepsy expert Prof. Graham Harding. Using his own flash and pattern analyzer Prof. Harding shows the results of testing some Nintendo games for seizure safety.

To view the ten-minute segment about video game seizures in the report on Nintendo, first go to www.youtube.com/watch?v=0aFhW56c2Vg and fast forward to about 5:15 into the clip. The seizure segment continues at the beginning of this clip.

The documentary was never aired in the US, and I’d long since given up searching for it online. But I recently came upon it thanks to John Ledford, who has been tracking seizure lawsuits filed against the game industry. John became blind in one eye as a result of his first grand mal seizure—which occurred while he was playing a video game in 1994.


Today the sound, tomorrow the picture?

too loud2Have you noticed that watching TV is less annoying lately? Commercials are now required to be no louder than the programming surrounding them. On December 13 an FCC regulation went into effect that was designed for just that. The CALM Act, approved by Congress in 2010, directed the Federal Communications Commission to make it possible to watch TV without constantly turning down the volume of advertisements.

Since the introduction of television in the 1950s, many consumers have complained to the FCC  about the loudness of commercials. What prevented the FCC from doing anything in response was that the issue was technically complicated. Multiple factors can contribute to the perceived loudness of a broadcast, including the strength of the electrical signal, the degree to which the sound signal is compressed. In addition, there was no standard method for content creators and broadcasters to measure broadcast volume.  

In 2006, the International Telecommunication Union–the same UN-affiliated standards body that has published specifications for protecting TV viewers from photosensitive seizures–proposed a new technique for measuring broadcast volume that allows uniform evaluation across national boundaries. In addition, the ITU proposed a numerical “target loudness” using the new loudness gauge. Thanks to the ITU, it became possible to define, comply with, and enforce limits on loudness.

Four years later the United States Congress passed the CALM Act with little debate, by unanimous vote in the Senate and by a voice vote in the House. California Congresswoman Anna Eshoo, who introduced the bill, said it was by far the most popular bill she’d ever sponsored. She said the bill “gives consumers peace of mind, because it puts them in control of the sound in their homes.” She was quoted saying, “If I’d saved 50 million children from some malady, people would not have the interest that they have in this.” By that time the UK, France, Norway, Italy, Japan, Brazil, Israel, Germany, Austria, Switzerland, Poland, and the Netherlands were already limiting the loudness of commercials or had begun action on the issue. 

These days even the video game industry is paying attention to some kind of audio standards, if only for consistency across products. According to an July 2012 interview in Designing Sound, Sony Computer Entertainment Europe is looking at smoothing out the volume among their own game titles.

Unfortunately, in this country making TV safer to watch for the visually sensitive–or making video games safer to play–isn’t on the legislative agenda. Consumers and policy makers aren’t aware of the need. The technical groundwork is already in place for regulations to prevent screen-induced photosensitive seizures, thanks to ITU specifications (and similar versions developed by the UK and Japan), and to similar guidelines adopted by the World Wide Web Consortium for web-based content.

Here’s where things stand at the moment in making US electronic screens safe for those with photosensitive epilepsy: Photosensitive epilepsy protection standards now apply to all federal agency websites. The Photosensitive Epilepsy Analysis Tool (PEAT) downloadable from the PACE Center at the University of Wisconsin at Madison makes available to website designers and software developers a free tool that tests screen content for compliance with seizure safety guidelines. The tool is not intended for entertainment industry developers, however; these companies need to buy commercially available assessment tools.

I’ve written previously about some of the complexities of bringing new screen safety standards to the American telecommunications industry. I”m going to learn more about the legislative process in coming months. My State Representative filed a bill last week to create a commission to study the issue of video game safety for minors at home and in school here in Massachusetts. It will take considerable time to even bring the bill to a public hearing, but as I’ve recently learned, all bills filed in the Massachusetts legislature receive a public hearing at some point in the two-year session. The two years just began this month. Stay tuned.


ADHD, video games, and seizures

I read an article this week about video games designed to treat ADHD. The concept sounds appealing:  use some time already spent on recreational video games to instead play therapeutic video games, and make ADHD treatment enjoyable enough that kids will stick with it. Another plus that developers point out is that treatment provided via games would not cause the side effects of ADHD medications. Games designed to improve some aspect of physical or mental health or performance are a fast-growing growing sector, and there’s even a scholarly research journal that launched this year, Games for Health Journal.

Video games are not without side effects, though, including seizures. ADHD, video games, and seizure vulnerability haven’t been studied together, but by piecing together some studies dealing with two of the three factors, the interconnectedness between them can be considered. So here is some information on ADHD and video games, and separately, information on ADHD and seizures. Put them together and think about about video games and ADHD being a risk factor for game-induced seizures. Developers of games to treat ADHD need to be conscious that the same neurological abnormalities that cause attention problems may also make people with ADHD more vulnerable to seizures from a video game.

ADHD and video games

Evidence is accumulating that exposure to typical (non-educational, non-therapeutic) video games is associated with later attention problems. It’s a highly charged subject, because scientists can never account for all possibilities and variables in a single study, and people tend to feel very strongly one way or the other about video games. A lot more study is needed because so little has been done that follows the same children over time. Based on findings including the following, the American Academy of Pediatrics issued cautions parents about video game use.

“…[A]mount of time spent playing video games is associated with greater attention problems…[B]oth television viewing and video game playing were uniquely associated with attention problems…[T]he total time spent with screen media (both television and video games) was positively related to attention problems.

…Exposure to screen media was associated with later attention problems even when earlier attention problems and gender were statistically controlled. This provides stronger evidence…that screen media may influence attention problems; controlling for earlier attention problems…rules out the possibility that the association between screen media use and attention problems is merely the result of children with attention problems being especially attracted to screen media.

…[T]elevision viewing and video game playing were associated with attention problems in both middle childhood and late adolescent/early adult samples…These similar associations across age groups raise an important possibility about the persistence of television or video game exposure effects on attention problems. Whatever the ages at which watching television or playing video games may increase attention problems, the consequences may be quite long lasting or cumulative.” 

–Edward Swing et al., “Television and Video Game Exposure and the Development of Attention Problems” in Pediatrics, August 2010

ADHD and seizures

While findings from one study were announced regarding the high rate of photosensitive epilepsy in autism, no studies have been published on photosensitive epilepsy in people with ADHD. What studies do show, however, is that in people with ADHD seizures of all types occur at a much higher rate than in the general population. The findings suggest that environmental influences, including video games, could place people with ADHD at higher risk for photosensitive seizures.

There is increasing evidence and acceptance of some underlying brain dysfunction shared by epilepsy and ADHD, and people with one disorder have more than the usual risk of having the other condition as well.

As one study puts it,

“It is likely that there is a common neurobiological predisposition for both a lower seizure threshold and ADHD behaviors that may involve both genetic and environmental factors… We found a 2.7 fold greater incidence of epilepsy among children with ADHD than in controls.”

– Shanlee Davis et al., “Epilepsy in Children With ADHD: A Population-Based Study” in Pediatric Neurology, May 2010

Another study found that children with the predominantly inattentive type of ADHD have a risk of developing seizures that’s 3.7 times the normal odds. The odds for children with the combined type of ADHD, which includes inattention and hyperactivity, are 3.3 times the normal rate.

“ADHD precedes the development of epilepsy, and ADHD or its determinants must be considered risk factors for epilepsy.”

–Dale Hesdorffer, et al., “ADHD as a Risk Factor for Incident Unprovoked Seizures and Epilepsy in Children” in Archives of General Psychiatry, July 2004***

This was specific to the inattentive type of ADHD, which is presumably the intended market for video games for helping with focus, memory, screening out distractions, etc.

ADHD + video games = higher likelihood of seizures 

I don’t know if games-for-health developers, particularly people working on ADHD treatment games, are more concerned about the seizure hazard than  developers of games for pure entertainment. Presumably a therapeutic application’s on-screen action would not be full of strobe effects. Without seeing the games, though, it’s hard to know for sure about the kinds of screens and effects that are used to congratulate users on their score, signal the end of the game, etc.

Let’s hope these games don’t do harm in their efforts to do good.

***Note that “incident unprovoked” in the study title refers to means a seizure that is not provoked by a medical situation unrelated to epilepsy: a head injury, fever, intoxication, and so on. A photosensitive seizure triggered by flash is not considered provoked, because that is the nature of reflex epilepsies, that they are triggered by a sensory experience. The terminology is more than just confusing. Because the words trigger and provoke are close to synonymous, the use of “unprovoked” in defining seizures typical of epilepsy seems to to exclude reflex seizures. The terminology both reflects and contributes to the relegation of reflex seizures to the sidelines of clinical training and research funding and and perpetuates the perception that they are rare.


Guess what: flash sells!

The marketing trailer for Tomb Raider was chosen as the best trailer at this year’s E3 show. It failed the seizure safety test in 2 visual sequences, as shown in this screen capture from the analysis software.

Earlier this month in Los Angeles the annual E3 (Electronic Entertainment Expo) trade show for computer and video games was held, providing an opportunity for game companies to showcase products that will be released in the coming year.

On the basis of demos, official marketing trailers, interviews with developers, and, no doubt, heavy lobbying behind the scenes, reviewers and game publications then choose their favorites in various game genres/categories (shooter, puzzle, strategy, action, etc.) for the major hardware platforms. Widely read IGN.com, the website of IGN (which describes itself as “a leading online media & services company obsessed with gaming, entertainment and everything guys enjoy”) also selected what it considered the best trailers at the show.

A compelling trailer shows the latest/greatest/neatest special effects, story lines, and characters, packaging them in a way to draw in viewers and help create that all-important “buzz” of anticipation. Parents and others can have a look at the content, age appropriateness, and perhaps get a sense whether seizure-provoking visuals are likely to be present. So, which trailers got top billing by IGN, and how much risk do the trailers themselves pose for people with photosensitivity?

None of the 4 games named in the best trailer category were clearly seizure-safe—they all included visual sequences that could provoke seizures in some people. Three of the four didn’t actually fail the seizure safety test, but they contained sequences that flirted with the guidelines for photosensitive seizure safety, meaning that very sensitive individuals under the right circumstances could experience a seizure. When tested for seizure safety, the three runners-up were given neither a Pass or Fail—they received a Caution rating by the Harding Flash & Pattern Analyzer.

Best trailer of show? The guys at IGN chose Tomb Raider, which during its three minutes exceeded seizure safety guidelines for flashing a couple of times and came close to failing in others. In addition, the moving title at the end that explodes in a screen of solid red was close to going over the guidelines not only for bright flash but also for the amount of bright red on screen. When the game is released next March, it will most likely affect photosensitive players. Trailers aside, Tomb Raider was also selected as best overall game in show…


PlayStation Vita games: seizure safe?

The logo sequence (top left) of PlayStation Blog’s “PULSE” can cause seizures, as shown by the luminance (flash) level registering in the Fail zone.

Are video games getting safer? Occasionally someone claims that game developers don’t make seizure-inducing games anymore–I have no idea what the basis is for this assumption. Today’s North American launch of the PlayStation Vita handheld platform provides an opportunity to see whether there might be any truth to such rumors. And the answer is…nah, I don’t think so.

In anticipation of today’s launch of Sony’s latest mobile gaming device, I viewed and tested gameplay sequences form trailers for 8 or 10 some Vita games available at launch time and in the near future. Although I did not find much material that failed the safety test in trailers I looked at, for several reasons I cannot state these games appear seizure safe.

  1. Because I’m not set up to test gameplay myself, to evaluate the seizure safety of video games, I rely on gameplay shown in the promotional trailers. From these snippets I can’t do a very thorough job of testing. I can’t tell how representative the clips are of all possible game action, and I can’t determine whether all the screen action that stays just inside the safety zone of the analyzer application would cross the line into the “failure” zone if the scene continued for another couple of seconds.
  2. I couldn’t accurately test most of the sequences for the Vita games because of the way the trailers were filmed. See explanation below.
  3. Even without testing the Vita games themselves, I found a consistent problem with logo graphics sequences in the game trailers that were unsafe. If Sony were committed to making its games seizure-safe, it’s hard to figure how the  marketing people could overlook the safety of their promotional videos, no?

Promotional trailers fail the seizure test!

Flash levels in a sequence (top left) from today’s PlayStation blog–announcing the Vita’s US availability–fail seizure safety test (above)

Every couple of weeks Sony posts a new edition of its PULSE promotional blog to keep customers current on upcoming games, marketing events, and product launch updates. To learn about the Vita’s features and the games line-up, I first went to Sony’s PlayStation blog, and the moving graphic that evolves into the PULSE logo on those blog entries creates a seizure risk! It consistently failed the Harding Flash and Pattern Analyzer seizure safety assessment.

Today’s PlayStation blog entry – in all the excitement of announcing the Vita’s arrival – has, in addition, an unsafe flash sequence that’s unrelated to the logo or to the game screen.

Filming format invalidates safety algorithms

Many of the PlayStation games are available across the whole family of PlayStation devices, so it doesn’t appear that there’s much difference in their screen graphics from one device to another. So watching a trailer for a PlayStation 3 game isn’t much different than watching the trailer for a Vita game. Except for one thing.

Most of the Vita trailers are shown with the game screen action taking up less than the full screen. Instead, the filmed gameplay is shown surrounded by the thick frame of the Vita device itself. This means that when the flash and pattern analyzer software calculates the effect of the game trailer’s visual stimuli, the impact of the stimuli will be significantly reduced. In other words, when trailers are filmed with a solid screen around them, the flash and pattern analyzer cannot follow its standard algorithms to determine compliance with photosensitive seizure safety guidelines, leaving me unable to test the safety of a given game sequence.

Game trailers for the PlayStation Vita often include a view of the controls. Gameplay takes up a smaller region of the screen, invalidating calculations used by the seizure safety analyzer.

Here’s why. Advice from experts on reducing the likelihood of visually induced seizures usually begins with not getting too close to the screen. That’s because the same flash that fills a smaller segment of your field of vision may be safe for viewing, whereas closer up it could have a greater impact on the brain. Because the game screen in these trailers takes up less than the full screen, the analyzer is “fooled” into assuming there is less significance to each bright flash.

To determine the level of visual stimulation produced by various types of seizure-provoking visual sequences on video, researchers created algorithms that take into account the percentage of the screen that is involved for each visual effect. So a bright flash that occupies the full screen is “scored” differently for safety than the same flash that takes up only 75 percent of it. The impact on the brain is lessened when the stimulus occupies a smaller area. For the same reason, experts recommend keeping a distance from TV and game screens, to lessen the portion of the visual field that is affected.

Am I missing something? If Sony or anyone else would like to set me straight on this, I’m listening.


2011: Inching toward fewer seizures from flashing electronic media

A huge amount of work is needed to protect consumers from the seizures triggered by flicker and flash from screens of everyday electronic media. But in 2011 there were some notable milestones in public awareness and prevention of photosensitive seizures. In no particular order, these are the year’s top five developments:

  1. A scene in the film Twilight Saga: Breaking Dawn triggered seizures in some audience members, most of whom had never experienced seizures before. Publicity about the seizures led to warnings by the UK’s Epilepsy Action and the Epilepsy Foundation of America. The film’s distributors provided a warning that cinemas could opt to provide to audiences. Although seizures triggered by movies shown in theaters aren’t common, this story brought wider attention to the risk of seizures from visual entertainment stimuli.
  2. Multinational game developer and distributor Ubisoft released a developers guide for creating video games that will not provoke visually induced seizures. Presumably it translates international guidelines for visual seizure safety into specific protocols for programmers. However, the guide is available only to member companies of TIGA, theUK’s trade association for video game developers and publishers.
  3. After the UK’s Epilepsy Action notified YouTube that an extended flashing segment in Kanye West’s music video “All of the Lights” could trigger seizures, a seizure warning was placed at the beginning of the video. It would be far better to fix than to keep the problem segments as is, even with a warning. Nobody pays attention to warnings, especially those who so far haven’t had a photosensitive seizure.
  4. Results of the first study to examine the rate of photosensitivity in young people on the autism spectrum were announced. They showed this population is at significantly increased risk of visually induced seizures. In young people 15 and older on the autism spectrum the photosensitivity rate is 25 percent. More studies are urgently needed, but with results as significant as these, more research will certainly be funded. While the study authors were focused more on commonalities in the roots of epilepsy and autism than on environmentally induced seizures in everyday life, the findings provide data that can be put to use immediately. The authors caution that it was too small a study (approximately 200 subjects) to merit placing limits on screen time. Nonetheless, parents of young people with autism spectrum disorders might want to be especially watchful of their children’s exposure to flashing electronic screens and any behaviors associated with screen time.
  5. Lenses that protect against visually induced seizures became readily commercially available. Zeiss F133  (previously known as Z1) cross-polarized, blue lenses can now be obtained from optician Antonio Bernabei, who ships worldwide from Rome. The lenses were developed by Zeiss with Italian photosensitivity researchers who demonstrated their effectiveness in clinical studies. In a study of people vulnerable to visually-induced seizures, while wearing the lenses 76 percent showed no abnormalities on EEG when tested with photic stimulation, and another 18 percent showed reduced EEG activation. Only 6 percent did not benefit at all. Until Bernabei began offering the lenses this past year, consumers and clinicians were unable to locate them without encountering a lot of dead ends.

These developments are more significant for the general public than most people realize because photosensitive seizures are not at all limited to individuals with epilepsy. Nobody knows for sure how many consumers experience visually induced seizures—including the small, unseen seizures that are never identified or reported. Three quarters of the affected people have no known history of seizures, no suspicion that they have this genetic vulnerability to flickering light, and therefore no prevention strategies. Onward to more progress in 2012!


UK game developers learn seizure safety tips

Publicity surrounding a 10-year-old boy's seizure from Ubisoft's game spurred the company to address the video game seizures problem.

Video game publishers across the UK now have access to guidelines for developing games that don’t trigger seizures, according to a story in yesterday’s Independent. Newcastle-based Ubisoft Reflections Ltd. has created a booklet for developers that is available to members of TIGA, the UK’s trade association for video game developers and publishers. This is an important step–which could eventually result in safer video games for those with photosensitive epilepsy.

Ubisoft has been a leader in publicly acknowledging the seizure risks of video games and pledging to create games that are seizure-safe. The company began addressing the problem after it was brought to public attention that a 10-year-old boy with no history of seizures experienced one while playing Ubisoft’s Rayman Raving Rabbids. His mother enlisted the support of her MP, John Penrose, who brought the safety issue before Parliament. Penrose proposed that video games published in the UK be subject to the same regulations that require all British broadcast TV programs and commercials to follow guidelines for seizure safety. In response to the threat of possible regulatory action by Parliament, the games industry is beginning to encourage its members to comply voluntarily with seizure safety guidelines. It will be interesting to see how many major developers climb on board.

Elected representatives in the US have not yet shown any interest in protecting the American public from visually induced seizures. Most are probably unaware that these seizures constitute a significant public health problem.  I have asked TIGA for access to the booklet so that I can report further on it here and explore how it might be adopted by the American game industry.


It happened once during a video game. Now what?

You were playing your usual MMORPG when you noticed that your vision was doing strange things, or maybe you had a funny feeling in your stomach, followed by a somewhat dazed and “out of it” feeling. Maybe a friend who was with you noticed you sitting and staring for about half a minute. The product literature, which you read very carefully (right!) before trying out this game for the first time, included warnings about possible seizures. So you check the literature again, do some online searches, and the symptoms you read about sound like what you’ve just experienced. This is all very strange. Where to go from here? What impact will this have on your life?

First, remember that you don’t have to have classic epilepsy — unprovoked seizures — in order to experience a seizure from bright flashes. Although the tendency to have seizures only from flash and flicker is often called photosensitive epilepsy, this name can be misleading and unnecessarily alarming. To be more precise and accurate, some researchers use the term visually induced seizures. Having a seizure during a video game does not mean you should assume you’ve developed epilepsy.

Of course, it could have been a one-time thing. Maybe there was some contributing circumstance (there often is). For example, maybe you were playing after sleeping only two hours the night before. Or you got ten hours of sleep but you sat in front of your console for four hours without taking a break. Or maybe you’d had more beer than usual. If you’re a woman, maybe you’re expecting your period. Maybe a new version/expansion of the game includes brighter, flashier screens? Do other things that flash ever make you feel strange or really uncomfortable? Flash photography, fireworks, emergency lights on police and fire vehicles? Fluorescent bulbs that aren’t working right?

If so, you’ll need to decide how you feel about the risk of experiencing more seizures from games with bright flashes. Depending on how severe the seizure symptoms and after-effects were, you might want to try exposure to the same game just to see if you begin to feel weird sensations again — for just long enough to begin feeling something strange — so you can stop playing as soon as you begin to feel something strange. (For some people, though, by the time they can feel as though a seizure is coming on, they aren’t able to take control of the situation to avert it.) If you try the same game again, at the same playing level, under similar circumstances, you may be able to determine if what happened was a fluke or maybe wasn’t even a seizure, after all. Then try playing it under different circumstances–on a full night’s sleep. Without alcohol, or whatever the contributing factor might have been. It might be that you’re fine unless you’ve got a specific set of factors that lower your seizure threshold.

If you are pretty sure the game’s given you at least one seizure, you need to think about taking precautions to avoid situations where you might be triggered again. Or, if you’re an adult, like Julian who posted his story on GameSpy, you can accept the fact that this is an occasional problem you’re willing to live with. I very much admire the candor of his story.  He understands why warnings exist and knows that as an adult he’s free to choose what works best for him. He knows he’ll get a seizure once in a while when he plays, and he’s OK with it. As he says, the seizure warnings are primarily for parents, whose children aren’t really mature enough to look after themselves and make those decisions. For many people, though, seizures are disruptive and somewhat disabling, and they affect access to driving a car, so the risk may not be worth it.

If you’re a young person living at home, you’ve got a dilemma about telling your parents. They probably never liked your games anyway, and thought you should be spending more time on doing homework and getting exercise. What if talking to them about this gives them the ammunition—as it were—to take away your Playstation? What if they become overprotective and worry about every flashing light you encounter from now to eternity? On the other hand, maybe this is something they ought to know about? If you have an employer, is it any of the company’s business? (This is a really tough issue but is probably not really pressing if your seizures have very specific, reasonably easy to control triggers. You wouldn’t be sitting at your desk playing World of Warcraft during lunch anyway, right?)

You might feel weird about telling your friends. Depending on your age and their maturity, some of them might appear to find this funny or see it as an excuse to point out you have a significant wimp factor. Besides, when kids get together they like to play video games. Do you really want to set yourself apart from the rest? How else could you possibly amuse yourself without your friends? (Test the waters by announcing you’re going gluten-free and see if they roll their eyes.) On the other hand, they might be impressed. Note the title of  former Internet TV show Epileptic Gaming, online games named The Epilepsy Game, etc.

Think the company that makes the video game wants to hear from you about your seizure? Not really, because they already told you so! They already warned you about seizures in the instruction manual! Occasionally consumers do take their seizure complaints to game developers and hardware manufacturers by filing a lawsuit. This is a long and stressful process.

Can a doctor help? If you decide to mention to a physician what happened, the most likely responses you will hear are:

  • “If the game bothers you, don’t play it. You should probably avoid strobe lights, too.”
  • “That’s extremely rare.”
  • “Doesn’t sound like a seizure. You would have had convulsions.”
  • “We don’t treat anyone for having just one seizure.”
 In coming posts I will be sharing more about the limitations of what doctors can do in this situation.

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