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.

Game forums blame pilot, natch

gamers blame players for video game seizuresWhile product liability suits don’t generally get a lot of respect, litigation is often an effective way to pressure manufacturers to make their products safer for consumers. In my last post I was wondering what the game forums would have to say about the lawsuit recently filed by John Ryan McLaughlin, a former F-18 pilot who has permanently lost his flight status as a result of a seizure he experienced while playing Oblivion: The Elder Scrolls IV.

A thick skin is required just to lurk on these forums because the level of hostility can be so high when posters comment on a perceived threat to a game or game company. Some of these game forums are populated by folks paid to post comments supportive of the company/industry, but I suspect most of the people who post their disdain for those with photosensitive epilepsy are just—how should I say this—lacking in social graces and emboldened by the anonymity of the Internet. As expected, talk of McLaughlin’s legal action quickly brought out contemptuous and often ill-informed postings.

Here are a few examples of what I found in the forums, somewhat sanitized. Most are plug-and-play responses that have been trotted out already in other discussions about video games provoking seizures:

  • The pilot should be grateful to the game for exposing a hidden condition he didn’t know he had. Especially since the consequences would likely be quite dire if a seizure had happened in the cockpit.
  • It’s probably a coincidence that the seizure happened while he was playing.
  • The poster has epilepsy and has never had a game seizure. So obviously there’s something fishy about the story.
  • If the game hadn’t triggered a seizure, something else would have.
  • Maybe his sensitivity to all that screen flashing developed from all the years of flying F-18s, and the video game just triggered a seizure.  (This one is my personal favorite.)
It all leaves me kind of speechless…

Navy pilot loses flight status after video game seizure

photosensitive pilot has first seizure from video gameA 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.

Some players don’t want seizure protection

video games seizure safety

The UK division of Ubisoft announced in 2007 that the company would voluntarily pre-screen and pre-test all video games developed in-house to check for seizure safety. The announcement came in response to discussion in Parliament regarding proposed measures to protect the public from video game seizures. Ubisoft had a particular interest in the matter because the mother of a 10-year-old boy who had a seizure while playing Ubisoft’s “Rayman: Raving Rabbids” brought the issue to her MP.

Ubisoft doesn’t always develop the games it distributes, however. Shortly before product release last week, Ubisoft placed an “anti-seizure” filter on “Cliffs of Dover,” the long-awaited fight simulator game developed by Russia’s 1C Company. Game forums have been filled with nasty rhetoric from users who resented the filter’s effect on game performance. Inaccuracies about game-induced seizures abound in these posts. Ubisoft acknowledged that the filter can slow the action by about 10 frames per second, depending on the user’s hardware configuration. After a few days of uproar in the forums, Ubisoft relented by allowing users to opt out of the filter. When they opt out, they will see the following message:

    WARNING: disabling this filter may induce previously undetected epileptic symptoms even in persons who have no history of prior seizures or epilepsy. Please read the complete warning on the game’s splash screen.

Ubisoft says the filter is a temporary approach to taming the flashes that are produced by active propellers, muzzle flashes, smoke puffs, explosions, falling bombs, and flying or taxiing between buildings, among other things. In the future Ubisoft plans to release patches to its software that correct the problem sequences in a less intrusive manner than the real-time filter.

Despite the stumble, Ubisoft is to be commended for publicly addressing the seizure problem and apparently extending its pre-testing to games they distribute but didn’t develop. Other game developers may be doing the same but would prefer not to disclose it. The problem with developers going public about fixing the seizure problem in their new releases, of course, is that the company’s entire backlist of products becomes a target for potential liability.

The video game industry needs to discuss the seizure problem publicly as it works to bring games into compliance with photosensitive seizure safety guidelines drawn up by researchers for image safety.