Child and adolescent psychiatrist Victoria Dunckley, MD has treated many young people with complex diagnoses and hard-to-treat conditions. She has seen that because electronic media overstimulate the brain, eliminating electronic screen time can be a very effective alternative or complement to psychiatric medications. Dr. Dunckley invited me onto her Psychology Today blog to write about the life-changing discovery that my daughter’s health was affected by unseen seizures from video games. Following is an excerpt:
I learned about video game seizures only after my daughter’s health, behavior, and cognitive functioning had suffered for several years. The effects of video games on her health and her daily function were pretty devastating. We didn’t fully realize how much she’d been impaired by all of the seizures until she got away from the screen. Fortunately, we were able to restore her health and greatly improve her daily life “just” by helping her eliminate video games from her life.
Here’s a glimpse of what life was like at home when she was gaming for hours each day. Alice seemed “out of it” a lot. Sometimes at the end of the day after lots of screen time she seemed to be on autopilot, in a dazed state. At times she didn’t seem to hear us talking to her. She began showing some odd behaviors that she didn’t remember later. Alice was alarmingly volatile, abnormally fatigued, and she struggled to concentrate in class. She missed a lot of school, because many days she couldn’t be awakened until the afternoon, despite our vigorous efforts. This wasn’t ordinary sleepiness. Read the full story
My daughter played video games to deliberately provoke photosensitive seizures during extended, inpatient EEG monitoring. She had plenty of seizures, but they weren’t detected by the EEG sensors on her scalp. Although she was exhausted and cognitively slow from all the seizure events, the clinicians said–based entirely on the EEG data–that they saw no sign of seizures. We’ve tried this at several hospitals, always leaving with this frustrating result.
Many patients with inconclusive EEGs are dismissed by neurologists and told there’s no evidence of seizures. This is probably even more frequently the case with visually induced seizures, since most neurologists know little about them. In their training they were taught that photosensitivity is extremely rare and that photosensitive seizures are big, generalized (grand mal) episodes.
Typically, neurologists are very conservative about issuing a diagnosis of epileptic seizures (although this was not always the case). If there’s an unmistakable seizure pattern on the EEG, they feel comfortable stating that you have seizures. Without clear EEG evidence, many neurologists may not feel a seizure diagnosis is justified. If this has happened to you, you’re not alone. Although clinicians are supposed to diagnose epilepsy based on the patient’s history as well as EEG and other tests, most often EEG results are considered more indicative than all other data–even though EEG is extremely imprecise. The result is that it can take years before a patient is properly diagnosed.
Here is a sampling from various reports we received on my daughter’s video game-induced seizures and the EEG recordings done during the events:
- “It is interesting that they almost always occur when she is alone.” [when she can concentrate fully on the game and more easily lose contact with her surroundings]
- “Most photosensitive seizures are primary generalized with bursts of spike waves, polyspike waves, or polyspikes. It is possible for some types of visual stimuli to bring on a partial seizure. These are more rare. Even in those instances, usually there is some sort of epileptic discharge.” [Oh.]
- “It is true that with surface EEG, we could miss partial seizures. At the same time, there are also many clinical signs that make a seizure unlikely…MRI has been normal and our clinical suspicions are quite low.” [Don’t seek and you shall not find.]
- “The EEGs have never shown epileptiform activity, nor has there been a photosensitive response.” [See my post on testing for photosensitivity using photic stimulation]
- “Due to the normal EEG and the precipitation of events with only limited stimuli, we feel it is unlikely that these events represent seizures.” [In other words, if only video games precipitate seizures, these can’t really be seizures.]
- “The patient was playing a video game and then stopped…There was no obvious change in the patient’s observed behavior in that she was sitting on a stool in front of a monitor playing a game…The EEG also did not show significant change…[She stopped playing the game—isn’t this a change in behavior?]
- “The two…events that were recorded…failed to reveal an identified behavioral change that would appear to be convulsive in nature.” [Since when are all seizures convulsive?]
- “The patient had a few jerks of her limbs during photic stimulation, but there was no electrographic correlate.” [Hmmmmm.]
- “There is a generalized irregular slow wave burst…at which time the patient is swaying her head to and fro while watching a video. This activity is not epileptic and most likely related to movement.” [An unsupported guess with no effort to gather more evidence. Ask the family if swaying the head to and fro is typical behavior. Or ask the patient if she recalls swaying while playing.]
Sound familiar? Anyone else want to share similar results?
Young people with autism spectrum disorders (ASD) are far more likely than the rest of the population to be photosensitive–susceptible to visually triggered seizures from flashing light, video games, and other strong visual stimuli. Results from a new study made public last week at the American Epilepsy Society annual meeting showed that fully 25 percent of those age 15 and up with ASD are photosensitive. In contrast, the prevalence of photosensitivity among typical young people is said to be 1 in 4,000 (although I believe this is an underestimate).
For some time I’ve suspected that the rate among ASD young people is elevated, and I’ve been attempting to find funding for a study that would examine young people with ASD and their risk of seizures from video games. Here are some reasons why I believe video games pose a particularly acute seizure risk to young people with autism:
- This population develops classic epilepsy at significantly higher rates than the general population
- Children with ASD have very high rates of sensory processing disorders, including difficulties with visual processing
- Children with ASD tend to spend their leisure time with electronic media, and they exhibit a preference for animated material, thus they are likely to be heavy users of video games
Not only are young people with ASD at higher risk of visually induced seizures, they are also less likely to have their seizures noticed and properly identified:
- The unusual repetitive and nonresponsive behaviors that are common in individuals with ASD can be difficult for an observer to distinguish from seizures
- In children with ASD, impaired executive function, energy, mood, attention, and cognitive ability resulting from seizures might be masked by pre-existing chronic deficits in these functions
My guess is that photosensitivity among young people with ADHD (attention deficit hyperactivity disorder) is probably higher than average, too, because of these same factors.
Here’s why this matters so much: Although it would be difficult to change game usage habits, parents of children with autism should exercise particular caution in allowing exposure to visually overstimulating images. Reducing or eliminating visually induced seizures could result in noticeable improvements in their children’s daily functioning. The last thing these vulnerable kids need is added interference, due to seizures, with cognitive and behavioral flexibility.
The study announced last week is the first to look at the photosensitivity rate in autism. It was performed at Children’s Hospital in Boston, where researchers investigated the EEG histories of children diagnosed with ASD. More research is certainly warranted, particularly since the photosensitivity assessments were done the usual way, using photic stimulation with a strobe light. Photic stimulation may show a person’s vulnerability to seizures from a strobe light, but a strobe does not recreate the experience of exposure to a video game screen. Some individuals who do not demonstrate an EEG response to the strobe may nevertheless experience seizures provoked by video games.
Parents who observe a child’s grades slipping may be quick to blame video game activity, reasoning that too many hours spent on video games has meant not enough time is being spent on homework and studying. The cause-and-effect relationship might not be that simple, though. Declining school performance among frequent, longtime gamers could be the result of reduced cognitive ability caused by undetected screen-induced seizures.
People who don’t experience recognizable seizures from video games may nonetheless have what are called subclinical seizures – events that qualify on EEG as seizures but don’t cause noticeable symptoms. (Subclinical seizures can happen to people who sometimes have very obvious seizures, too.) How would you know about seizures that can’t be seen and that the child is not aware of? You probably wouldn’t, unless you had EEG testing done that showed abnormal response to photic stimulation.
Over time, if seizures continued to happen fairly frequently, you might notice some memory problems or less alertness, which also could be due to stress or depression or many other causes. Research on the effects of short, nonconvulsive seizures that have no symptoms suggests that after many seizures over a period of time, there’s a cumulative impairment of the ability to acquire and retain information. “The clinical relevance of this…is that early detection of the cognitive impact of seizure-related activity and subsequent treatment may prevent a detrimental impact on cognitive and educational development,” according to a 2004 study in the journal Epilepsia.
The same authors note in an earlier paper that the cognitive functions most affected by frequent, hard-to-detect seizures are short-term memory and alertness. “Often these [nonconvulsive] seizures present as behavior fluctuations or attentional disorders and can therefore persist during a longer period.” This means that individuals with existing behavioral issues or attention problems are less likely to notice these changes or to have them noticed by others.
People with short, nonconvulsive seizures who remain untreated for a long time demonstrate lower IQ scores. Performance on IQ tests and in daily life is generally reported to improve when seizures are brought under control. “In children with difficult-to-detect seizures, the authors reported “sudden and unanticipated decline of school performance as the first symptom, again as a result of the accumulating effect of such seizures on cognitive function.”
In short, we know from research studies that:
- video games can cause seizures
- visually-induced seizures can happen to anyone, including those without epilepsy
- some seizures aren’t detected because they have no symptoms
- even seizures that have no symptoms can cause cognitive impairments
Put them all together, and it’s clear all video games need to be made seizure-safe, because seizures can happen to anyone, and, undetected, they can continue to occur and impair functioning for years. Parents, legislators, regulatory agencies, game developers, and the entertainment software industry have been standing by and allowing unknown numbers of children to lose strength in some of their core mental abilities, most likely for years at a time. The UK, which requires broadcast TV to be seizure-safe, is moving in the direction of seizure-safe games. How long will it take and how many lives will be diminished before stakeholders everywhere pay attention to this public health problem?
A local health feature broadcast this week in South Bend, Indiana credits the Wii for helping doctors identify where in the brain children’s seizures occur. When patients are in the hospital for seizure monitoring, doctors want to capture actual seizures in order to gather potentially valuable EEG data. If seizures don’t occur with the monitoring equipment in place, it’s a missed opportunity to collect information doctors can use to guide seizure treatment.
To increase the chances that seizures can be captured during the EEG monitoring, now the kids play Wii games! Thanks to the Wii, seizures are more likely to happen when they can be most helpful to doctors. The Wii has allowed seizures to be recorded on EEG in at least 25 percent more patients, according to the story.
“The most important purpose is to get them tired. We know that if you’re very tired, you’re more prone to have seizures,” explains Dr. Angel Hernandez, the neurologist interviewed for the story. Although fatigue lowers the body’s seizure threshold, it’s not the fatigue itself that produces the seizure. No matter how tired you are, without the visual stimulation of the video game, you’re not very likely to have a seizure.
Of course, the elephant in the room here is that video games do commonly trigger seizures, whether or not doctors deliberately provoke them and whether or not they are even noticeable events. You don’t really need to tire out the kids with the physical activity of Wii games. Just get them seated with any brightly flashing game screens, and you can produce the same results. Unfortunately the health reporter for this story did not explore the problem that is the flip side of Wii as a seizure trigger. I have to wonder how pleased Nintendo’s public relations people are with this particular feature story.
Probably the biggest reason there’s so little awareness of video game seizures is that many seizures aren’t noticed or identified.
Some seizures are events you can’t miss: a person falls to the ground, loses consciousness, and has a lot of uncontrolled body movements. But only certain types of seizures look like that. Visible signs and symptoms differ in each person, depending on the precise areas of the brain affected, but repeated seizures in the same person tend to look similar.
Watch this clip of a brief video game seizure recorded during a video EEG performed in a hospital. Some seizures are more subtle than this one. Although here the patient’s upper body jerks backward, she doesn’t lose her balance or stop looking at the game on the computer screen. When the seizure is over, she may notice that her character died or that something else went wrong in the game while she was not responding normally. If consciousness is impaired by the seizure, she might not recall the seizure itself. [Note: I recommend reading the piece this clip appears in from the Center on Media and Child Health at Children’s Hospital Boston.]
When a person plays a video game all alone or facing away from others in the room, there may be no opportunity for others to observe quiet staring, eye flutter, changes in facial expression, or small movements that may be the only outward signs of a seizure. The person who has the seizure, whose consciousness may be altered by it, may have no recollection at all of the seizure and therefore may have no idea that anything unusual happened. Studies have shown that even people who know they have a seizure condition may have no idea that they’ve just had one, unless they find themselves injured or in a different position/place than they remember. How many people are walking around in a post-seizure state of problems with memory, mood, sleep, appetite, concentration, and more–without even realizing it? No way to know, and a frightening thought.
Update, 5/15/12 – Watch a brief interview with a neurologist describing subtle seizures.
Most people who experience video game seizures have a condition called photosensitivity, whereby flashing or flickering light disrupts the brain’s normal electrical patterns and produces epileptic discharges. For these people a bright light flashing at certain frequencies (the number of flashes per second) can lead to the firing patterns of spikes and waves that occur during seizures. In the 1940s scientists discovered that a flashing strobe light can cause the brain to generate abnormal discharges that can be detected on EEG.
So as part of a routine EEG, a strobe light flashing at a range of frequencies is placed in front of the patient. The procedure is called intermittent photic stimulation, or IPS. IPS is the most widely used method of assessing susceptibility to visually induced seizures. The EEG and patient are watched closely, and if abnormal discharges or unusual symptoms appear, testing at that frequency stops right away, before a seizure develops.
Unfortunately, as with so much of the data used in seizure diagnostics, there is a lot of uncertainty about the meaning of photic stimulation test results. A negative result when testing for photosensitivity means simply that no seizure-like discharges were detected on EEG scalp electrodes and/or judged significant under the IPS testing conditions that were used. A positive finding may indeed point to vulnerability to seizures from flashing visual stimuli. However, in as many as 8 percent of the non-epilepsy population, particularly in children and adolescent girls, IPS produces a positive result that may have no clinical significance. A positive test for photosensitivity suggests (but does not prove) the following:
- Because photosensitivity is characteristic of certain types of epilepsy, the patient may have one of those types. However, some people who never have seizures of any kind produce these discharges in the presence of a strobe light.
- Since these abnormal discharges appear in response to a flashing light, the patient may be more likely to experience seizures when exposed to other sources of flash and flicker. The patient should be cautious about exposure to these visual stimuli
Compounding the weaknesses of EEG as a diagnostic tool for seizures, many procedural issues affect the accuracy of EEG results for determining photosensitivity. Results can be influenced by many things, including:
- The type of strobe light used, including its shape and how diffuse the light is
- The distance of the strobe light from the patient’s eyes
- Whether the patient’s eyes were open or closed when the flashes and discharges occurred
- Which flash frequencies were used (some people have an abnormal response only to a narrow range of frequencies)
- The brightness of the flash
- The wavelengths of the strobe light—the presence of certain colors in it
- The assessing physician’s interpretation of the EEG—how abnormal are the altered wave patterns?
- The assessing physician and the technician’s observations of the patient’s symptoms/behavior during the procedure
- Whether the patient’s symptoms/behavior during the procedure are considered along with the EEG record
Some people who have seizures from video games do not show an abnormal response to photic stimulation. After all, the experience of playing a video game isn’t the same as viewing a pulsating strobe light. Other diagnostic tests for sensitivity to the visual experience of playing a video game — the movement of patterns and rapid fluctuations of colors — have been developed but are not widely available.
Update, 7/23/2014: Please read here about a new study that found only 6.2% of patients with a history of visually induced seizures showed a positive result on EEG during photic stimulation.
A couple of weeks ago I mentioned at the end of my post that most physicians are limited in what they can offer a person experiencing visually induced seizures. If a doctor investigates possible seizures, an EEG (electroencephalogram) is usually the first diagnostic procedure. EEGs can (sometimes) detect problems with the electrical function in the brain.
If you’re told that an EEG “didn’t find anything,” don’t assume there was nothing to be found. Many issues can and do routinely interfere with the accuracy of EEG results, an open secret that clinicians rarely share with patients. In today’s post, I’ll present some of the shortcomings of EEG when used for seizure detection, as described by experts.
Let’s start with this:
“The main limitation with EEG is its poor sensitivity for epilepsy. The generally accepted numbers are that the yield of a single routine EEG in epilepsy is ~ 50% and increases with repeated EEG recordings to reach about 80% by the third recording.”
Source: Selim R. Benbadis, “Introduction to Sleep Electroencephalography” in Sleep: A Comprehensive Handbook, edited by T. Lee-Chiong, John Wiley & Sons, Inc., 2006
Translation: EEG is more useful in assessing conditions such as coma, stroke, tumors, and brain death than it is in accurately detecting seizure activity. Half of routine EEGs don’t pick up seizure activity during the first recording. In cases proven to involve seizure activity, if the EEG is repeated a couple of times, 80 percent of them will capture evidence of seizures.
“While…often adequate for the appropriate diagnosis of a seizure disorder, patients with epilepsy can have persistently normal EEGs.”
Source: Gregory A. Worrell, Terrence D. Lagerlund, and Jeffrey R. Buchhalter,“Role and Limitations of Routine and Ambulatory Scalp Electroencephalography in Diagnosing and Managing Seizures.” Mayo Clinic Proceedings September 2002**
Translation: A seizure disorder should be diagnosed on the basis of the clinician’s judgment, using information from the patient’s history, the clinician’s own observations/examination, and diagnostic tests. Doctors should not allow EEG results alone to drive the diagnosis, and patients should question a diagnosis that is based primarily or exclusively on the EEG.
“The human electroencephalogram (EEG) was discovered by the German psychiatrist, Hans Berger, in 1929…EEG continues to play a central role in diagnosis and management of patients with seizure disorders—in conjunction with the now remarkable variety of other diagnostic techniques developed over the last 30 or so years—because it is a convenient and relatively inexpensive way to demonstrate the physiological manifestations of abnormal cortical excitability that underlie epilepsy.”
Source: Shelagh J.M. Smith, “EEG in the diagnosis, classification, and management of patients with epilepsy.” Journal of Neurology, Neurosurgery, and Psychiatry June 2005
Translation: Folks, EEG is pretty old technology. It was updated to incorporate digital technology, so that instead of recording the data on paper (think of seismographs), results are now viewed and stored on computers. However, the capture of electrical signals from inside the brain using electrodes on the scalp is much the same as it was in 1929. More specifically,
- There are other diagnostic procedures that have been developed more recently. (You may find it difficult to convince a neurologist to order one of these others, though, without having some evidence of seizures showing on the EEG. A real Catch-22.)
- EEG is economical for providers and risk-free/non-invasive for patients.
Ready to get just a little technical? Remember, a translation follows:
“Despite the importance and widespread use of scalp EEG epileptiform discharges, the cortical EEG substrates underlying these spikes and seizure discharges are mostly speculative…the cortical area of epileptiform discharges required for the scalp recording is considerably larger than commonly thought. A cortical area of 10 to 20 cm is often required to generate a scalp recognizable interictal spike or ictal rhythm. Sufficient cortical source area and synchrony are mandatory factors for the corresponding scalp EEG epileptiform recording.”
Source: J.X. Tao, M. Baldwin, S. Hawes-Ebersole, J.S. Ebersole, “Cortical substrates of scalp EEG epileptiform discharges.” Journal of Clinical Neurophysiology April 2007
Translation: Data retrieved via EEG requires a lot of guesswork to figure out what is really going on inside the brain, and where.
- EEG electrodes glued onto the scalp do a so-so job of picking up the brainwaves that signal a seizure. For one thing, the skull gets in the way…for another, brain tissue.
- Scalp electrodes aren’t great at correctly identifying the location of abnormal discharges, either.
- Seizures involving only a small portion of the brain may not generate a strong enough electrical charge to pass through the skull for detection on the scalp.
- The spike and wave patterns on an EEG that characterize seizure discharges must arrive at the scalp undistorted by the intervening structures (many do not reach the scalp without distortion), or the waves will not clearly show seizure activity occurring.
Are you developing some healthy skepticism? Good! Next up: Using EEG to test for sensitivity to flash/flicker carries a whole set of additional challenges that further limit EEG’s usefulness.
**full text available here
Update, 7/26/2014: Please read here about a new study that found only 6.2% of patients with a history of visually induced seizures showed a positive result on EEG during photic stimulation.
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.”
A former Navy pilot permanently lost his flight status after experiencing a seizure while playing the game Oblivion: The Elder Scrolls IV on a Sony Playstation 3. John Ryan McLaughlin, an F-18 pilot based in San Diego, also broke a bone in the incident. McLaughlin has filed suit against the game manufacturer, Bethesda Softworks, and Zenimax Media, its corporate parent, as well as Sony. Read the story here.
Note that pilots are very, very carefully screened for possible seizure disorders–using photic stimulation, which really can’t replicate the visual experience of a video game. I have to wonder how the game forums will respond to this…usually these commenters love to blame the parents of children who have video game seizures, claiming everyone should have anticipated it would happen. This very sobering case involves someone highly trained to defend our country, who’s been tested up and down to detect even the hint of a seizure problem, who now can’t use his flight training anymore. Ever. Are the game forums going to blame a guy who’s been certified seizure-free for not paying attention to a warning in the game’s user manual? Or maybe find his parents responsible?
Read more about lawsuits filed by consumers who experienced seizures from video games.