Photosensitive epilepsy in the 2016 election
Posted: 10/18/2016 Filed under: Legal Action, Media Coverage, Protective Lenses | Tags: flash, flicker, photosensitive epilepsy, seizures Leave a comment
In recent weeks photosensitive epilepsy received some media attention because of two developments in the 2016 presidential campaign. Who would have thought? While the public probably didn’t learn much about photosensitive seizures in either case, perhaps both situations contributed something to public awareness of seizures triggered by certain lighting effects and images…
Clinton’s blue sunglasses
After Hillary Clinton’s widely publicized medical emergency on September 11, various bloggers and political writers rushed to speculate about possible causes of the episode. Photos of Clinton taken that day showed her wearing sunglasses that appeared dark blue, and some people wondered whether the glasses provided a clue to an undisclosed medical condition.
Hillary Clinton attending September 11 ceremony in New York
Visits to this blog surged for several days. More than 95 percent of the nearly 24,000 visitors from September 11 – 13 read two of my prior posts about blue lenses that protect against visually induced seizures. A few readers questioned whether the sunglasses seen on Clinton were the type worn to prevent photosensitive seizures.
My answer was maybe yes, but probably not. Since photos of Clinton that day showed her wearing them outside during the day, they weren’t likely worn for seizure protection. Flickering light doesn’t generally trigger seizures outdoors in daylight and good weather—for flicker to occur there has to be an extreme contrast of light and darkness in rapid succession. It’s certainly possible to have photosensitive seizures triggered outside in daylight, in specific situations: sunlight reflected on a body of water, or a line of trees seen from a moving vehicle, where sunlight is broken up by trees alongside the road. But Clinton was not in those settings when wearing the glasses.
Seizure-inducing images tweeted by angry reader
In a separate election-related incident, the matter of photosensitive seizures was taken in a troubling direction. In response to articles he wrote critical of Donald Drumpf, Newsweek journalist Kurt Eichenwald received a menacing tweet from an unhappy reader that referred to Eichenwald’s epilepsy and included an embedded video of flashing images. When the video started, Eichenwald dropped his iPad before a seizure could develop.
It certainly wasn’t the first time seizure-inducing images were placed online for the purpose of triggering people with photosensitive epilepsy, but it’s the first instance I’m aware of that’s tied to this rancorous political season. Criminal defense attorney Scott Greenfield claimed in his blog that the episode qualifies as an attempted assault. “Yes, even Twitter can be used to commit an assault, regardless of whether Eichenwald was a victim,” he wrote.
For more on the legal and technology issues raised by the tweet to Eichenwald, check out this Future Tense article, in which UC Davis law professor Elizabeth Joh concludes, “…the existing tools of criminal law probably do address a tweet likely intended to harm its recipient or to create a reasonable apprehension of fear in him.” But she adds, “That doesn’t speak to the likelihood of prosecuting the troll, which may be low.”
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Google’s Doodle Fruit Games: Seizure, anyone?
Posted: 08/07/2016 Filed under: Photosensitive Seizure Prevention, Results of safety testing, Seizure Risk, Seizure Warnings | Tags: 2012 Olympics logo, computer games, epilepsy, flash, flicker, Google, photosensitive epilepsy, seizure prevention, seizure warning, video games 1 Comment
Google’s landing page is featuring various doodles that celebrate the Rio Olympics and promote a fruit-themed games app. The doodles lead visitors to a promotional trailer about the app.
What do a pineapple playing tennis and a grape going for a ride have in common? Two things: 1) They’re currently appearing in Google’s Olympics-themed iOS and Android Doodle Fruit Games app, and 2) viewing them in Google’s video promoting the app could give you a seizure.
For the next two weeks while the game app is available, Google is promoting it with a zippy, fast-paced trailer. Visitors watching the trailer see rapidly moving images images that could provoke seizures in anyone with a condition known as photosensitive epilepsy. I tested the trailer for its risk of inducing seizures and found two segments–involving the aforementioned pineapple and grape–with a flashing effect that could trigger photosensitive seizures. From what I can tell, the problem images appear only in the trailer and not in the games app itself–unless they appear only after players achieve a high score that I didn’t reach.
Google’s promotional trailer at g.co/fruit contains images that can trigger seizures in some viewers.
This image of a pineapple wielding a tennis racquet is from one of two segments in the trailer that could provoke a seizure.
What is photosensitive epilepsy?
Photosensitive epilepsy is more common than is generally known, and researchers agree it is probably underestimated. People with the condition have epileptic seizures triggered by lights or images that flash faster than three times per second.
It gained some notoriety after a Pokémon cartoon shown on Japanese TV in 1997 sent nearly 600 children to emergency rooms with seizure symptoms. The condition had already been extensively studied and researchers had drawn up guidelines for reducing the seizure risk from video images, but at the time Japan did not protect TV viewers from problem images.
Who is affected by photosensitive epilepsy?
The vast majority of those with “regular” epilepsy are not affected by visual stimuli. But photosensitive epilepsy may be harder to detect and is underrecognized by the public and by doctors. You may be susceptible to photosensitive seizures and not even realize it since:
- Photosensitive epilepsy typically doesn’t develop until adolescence.
- It can occur in people with no history of seizures. Of Japanese children affected by the Pokémon cartoon, 76 percent had never before experienced a seizure.
- People with other forms of epilepsy are routinely tested for photosensitive epilepsy, but the condition may be most common in individuals who don’t have any other type of seizures. These people are very unlikely to be screened for it.
You can already be experiencing seizures and not know it.
- Not all seizures involve complete loss of consciousness, falling, or body movement observable by others. Such major events, known as generalized seizures, occurred in less than half of the Pokémon-affected children.
- Because consciousness is altered at the time, a person having a seizure often has no memory of it.
Even if you have no visible symptoms of a seizure, there can be lingering after-effects that include fatigue, sleep, learning, and memory problems, mood irregularities, among others.
How the media and entertainment industry can reduce seizure risk
More than 20 years ago, researchers studying photosensitive epilepsy defined the factors, in particular the flash frequency, that are most likely to provoke visually induced seizures.The UK has required all TV content to conform to seizure-reduction guidelines since 1994, and Japan enacted similar regulations following the Pokémon incident. To date, no other countries have done this, but a United Nations-affiliated agency did adopt recommendations for reducing photosensitive seizure provocation from television. Meanwhile, of course, interactive media have become a much bigger part of our lives than television, and the same guidelines for reducing seizures from TV should be adapted to the internet.
Seizures from a Pokémon cartoon shown in Japan drew attention to photosensitive epilepsy in 1997.
The World Wide Web Consortium (WC3), the international group that produces website accessibility standards for all types of applications, now includes guidelines for reducing the risk of visually triggered seizures. But incorporating such standards into private industry applications and sites is a hugely complex and time-consuming process.
The United States Department of Justice has been considering since 2010 the complexities of creating regulations ensuring access by the disabled to public and private websites. The DOJ announced this spring that rules governing private websites have been delayed until 2018 at the earliest.
In 19901, after a few consumer lawsuits were filed due to seizures, game developers began including a seizure warning that has kept consumers from filing or winning such lawsuits. Although most game documentation and packaging contain a seizure warning, not all games contain seizure-provoking visuals. Consumers don’t know which games actually have potentially harmful sequences and largely ignore the warnings.
How you can prevent photosensitive seizures
If you’re susceptible, even a brief exposure of a few seconds to flashing can be enough to bring on a seizure. If you know that you are vulnerable to these seizures, there are some precautions doctors recommend to avoid being triggered:
- When possible, avoid situations and stimuli that are likely to be provocative, including emergency lights, electronic billboards, video games, light shows, flickering fluorescent lights, fireworks, animé and other fast-moving cartoons
- Wear blue-colored glasses, which filter out the most provocative light frequencies. Most opticians can make these inexpensively.
- In the presence of flashing light, cover one eye.
- Increase your distance if possible from the flashing image–so, for example, stay at least 6 feet from your TV screen, and don’t play video games up close.
- Don’t play when fatigued or sleep-deprived.
- Take frequent breaks during prolonged exposure–although this won’t always help if you are triggered in a matter of seconds.
Testing for visuals that can provoke seizures
The results of testing the Google trailer with an image analysis tool are shown in this screen grab. Oscillating vertical stripes in the cartoon image in the upper left of the screen create a flashing effect that fail to meet guidelines for reducing the risk of photosensitive seizures.
I tested the trailer using an industry-standard application called the Harding Flash and Pattern Analyzer that detects image sequences that can trigger photosensitive seizures. It is based on algorithms devised by Graham Harding, one of the world’s leading experts on photosensitive epilepsy. The application is widely used by producers and networks in the UK—including by the BBC—to reduce the risk of seizures from material on broadcast TV. The analyzer examines video sequences frame by frame for very specific and measurable image qualities that researchers have found can trigger seizures.
Seizures from video shown on TV about 2012 Olympics logo
A video introducing the 2012 London Olympics logo was withdrawn in the UK after some viewers reported seizures.
This is not the first time that Olympics-themed promotional visuals have placed viewers at risk of seizures. A promotional video for the logo of 2012 London Olympics logo shown on British TV news in 2007 resulted in seizures in some viewers. It had not undergone the required testing that would have alerted producers to the problem prior to broadcast.
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Video games inspire theme parks
Posted: 06/06/2016 Filed under: Theme Parks | Tags: Nintendo, photosensitive epilepsy, seizures, Ubisoft, video games Leave a comment
Mass Effect: New Earth debuted May 18 at the Great America theme park in Santa Clara, CA.
People who have photosensitive epilepsy probably are already cautious about going to amusement parks, since lots of rides and other attractions feature fast-moving lights and flashing images. Now there’s another reason they should be wary: video game-based attractions are coming to amusement parks, and some of those games have seizure-inducing images.
“The game manufacturers and game designers want to have a place to show their games at a scale that you can’t do in your house,” according to the CEO of Cedar Fair Entertainment Company, which owns 11 amusement parks. To put it another way, they’re blowing up the visuals of an action video game with seizure risks, and displaying those images on a huge screen!
Here’s the problem with that: Images on an oversized screen have a greater impact on the brain’s visual cortex than the same images viewed smaller. This means that even if a person with some degree of visual sensitivity plays Mass Effect on an Xbox, without incident, that person would be more likely to experience a seizure at the theme park attraction.
Games don’t comply with seizure guidelines
The Mass Effect attraction is viewed on a 60-foot screen, behind a live actor (lower right)
An attraction based on BioWare’s Mass Effect opened last month at California’s Great America theme park—on a 60-foot LED screen. Curious about whether the at-home games contain potentially seizure-provoking images, I tested** the images in promotional trailers for Mass Effect 3 and Mass Effect 4. I found violations of seizure reduction guidelines in both. A 15-second commercial for Mass Effect: New Earth also fails the test for compliance with the guidelines.
a frame from the Plants vs. Zombies Garden Warfare PlayStation launch trailer
At North Carolina’s Carowinds amusement park, “the world’s first intra-active 3-D game experience” Plants vs. Zombies Garden Warfare: 3Z Arena opened in March. It’s shown on screens measuring 14.4 x 26 feet.
The attraction is based on the Plants vs. Zombies franchise. In my tests, some clips from the Plants vs. Zombies Garden Warfare game violate seizure reduction guidelines. I didn’t have video I could test of the park’s big-screen experience.
When designing an attraction based on a game with seizure-provoking images, shouldn’t the theme park industry be especially mindful of patrons with photosensitive epilepsy? Warnings at the park about rides that could be hazardous to patrons with certain medical conditions such as pregnancy, heart conditions, or epilepsy aren’t enough. Many people don’t even know about their vulnerability to seizures from certain visual effects until they have an unmistakable seizure. Not all seizures are easily noticeable! And even small seizures that aren’t seen can leave impairing after-effects.
Coming next: Entire theme parks based on games
Video game-based attractions at amusement parks are expected to multiply. Universal Studios and Nintendo signed a deal last year to bring Nintendo-based attractions to Universal’s theme parks. The first of these, slated for 2020 completion, will be a whole section of Nintendo-based attractions at an existing theme park in Osaka, Japan. Industry observers suspect that Universal’s recent land purchase in Orlando is intended for a Nintendo-based expansion of its Universal Orlando theme park. Ubisoft has announced an entire “next generation theme park” scheduled to open in 2020 in Kuala Lampur, Malaysia, with rides and attractions based on its portfolio of game franchises.
**Seizure reduction guidelines and testing images for compliance
You can read about seizure reduction guidelines here–they were developed in the UK to reduce the risk of seizures induced by TV. All material broadcast on UK television must comply with the guidelines.
To test images for the likelihood of provoking photosensitive seizures, I run downloaded video clips through an application called the Harding Flash and Pattern Analyzer. (Graham Harding is one of the world’s leading experts on photosensitive epilepsy.) The FPA is widely used by producers and networks in the UK—including by the BBC—to reduce the risk of seizures from material on broadcast TV.
The analyzer examines video sequences frame by frame for very specific and measurable image qualities that researchers have found can trigger seizures. When such images are found, it displays and indicates the specific frames that violate seizure reduction guidelines. Violations occur with:
- rapidly alternating light and dark images (flash/flicker)
- certain stripes and geometric patterns with high contrast
- large areas of very bright (“saturated”) red
- problem images take up more than one quarter of the total screen area
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Video game images migrate to movies
Posted: 04/26/2016 Filed under: Movies | Tags: computer games, epilepsy, flash, photosensitive epilepsy, seizures, video games Leave a comment
Hardcore Henry was filmed in the style of a first-person shooter game.
Terrible idea. Take a genre of video games—first person shooter– that is especially likely to provoke seizures. Make an action movie filmed entirely in that style. Put it on the big screen for release in theaters. The larger an image is, the greater the area affected in the brain’s visual cortex, and therefore the risk of visually triggered seizures is increased in those who are vulnerable.
Hardcore Henry opened (and in most cases, also closed) in theaters this month. It’s described by the student newspaper of Washington College as 90 minutes of “non-stop chase scenes, splatterhouse shootouts, and barely comprehensible fistfights that often end in ridiculous dismemberment.” Glenn Kenny’s New York Times review explains the film’s R rating thusly: “for not letting a minute pass without subjecting one character or another to grievous bodily harm or worse.”
I suppose it’s possible to produce such subject matter without seizure-inducing images, but given such descriptions of the content, I wanted to check. Without going the movie. So I tested** the movie’s promotional trailers for compliance with seizure reduction guidelines. The guidelines were designed to protect all but 3 percent of those who may have seizures triggered by visual stimuli. After watching the trailers (I do not have photosensitive epilepsy), I was not at all surprised that the movie does not comply.
This is hardly the first movie to include images that could trigger seizures. But based on the trailers and reviewers’ accounts of a relentless pace of action, most likely there are many potential seizure triggers during the film. Researchers of photosensitive epilepsy believe there is a cumulative effect on the brain; the risk of a seizure increases after prolonged exposure to potential triggers.
Review: “non-stop chase scenes, splatterhouse shootouts, and barely comprehensible fistfights that often end in ridiculous dismemberment.”
Strong stomach required
Many reviewers of Hardcore Henry cautioned readers about motion sickness. One reviewer interviewed the movie’s producer about apparently significant (yet not entirely successful) efforts to minimize it. The producer said those efforts were begun long before film production began, with many tests and test screenings.
Some representative remarks:
“…many people are going to feel ill when they try to watch Hardcore Henry on the big screen…make sure everyone in your party either has no issue with motion sickness, has taken their Dramamine, or rolls into the theater with an empty stomach…” — The Daily Dot
“…as I waited for my nausea to subside, I began to appreciate the dastardly marketing plan built into Hardcore Henry: It’s essentially a dare to see if audiences can finish the whole thing without throwing up.” — Vox.com
“Hardcore Henry will probably go down as the film of 2016 that is most likely to make you feel nauseous from watching it (due to motion sickness, that is, not the gory, over the top violence).” — Screenrant.com
Back-handed seizure warnings
A number of reviewers mentioned seizures, but not with the same concern with which they write about motion sickness. Sure, motion sickness is unpleasant, but a seizure is not only unpleasant, it can be dangerous and life-altering, and its effects on the brain can linger. You wouldn’t know it from these reviewer comments, though:
“It’s remarkably watchable, in fact, with none of the motion sickness you might expect, which is especially amazing given the film’s unswerving dedication to full-bore, seizure-inducing action.” – The Georgia Straight
“…Hardcore Henry is a 90-Minute Cinematic Seizure…a frenetic editing style that can make you feel like you’re having some kind of seizure…I don’t see how anyone could watch it and not experience motion sickness…I definitely felt like I’d suffered from some sort of brain trauma when I walked out of the theater. (Can you get a concussion just from watching a movie?)” — Esquire
Treating seizures (and those who have them) with respect:
Just 2 reviews of dozens I read seemed to be genuinely concerned about the movie’s potential to trigger photosensitive seizures in audience members:
“If 3D gives you a headache, Hardcore Henry is enough to bring on epilepsy.” — Moviehole.net
“I left the theater wondering if the jittering, disoriented feeling I had buzzing through my skull was some sort of sudden onset epilepsy.” — University News
Review: “like sensory assault and battery”
If you live in the UK, there are real warnings about the risk of visually induced seizures. Listings for movies with images that don’t comply with seizure reduction guidelines warn of “a sequence of flashing lights which might affect customers who are susceptible to photosensitive epilepsy.” That’s because the UK regulates the appearance of TV, movies, and advertising to protect those individuals. Some of these people with photosensitive epilepsy don’t realize they have the condition. It may have developed only recently or it’s quite possible they were never aware of experiencing a seizure. Not all seizures look like what you typically see portrayed.
What lies ahead?
What’s most worrisome is that the consensus among reviewers — regardless of how well they liked Hardcore Henry — is that the influence of video games on movie-making is only going to grow.
“Virtual reality is on the way. Video games and movies will soon start to blend and borrow from one another in many ways. And this movie, imperfect and nasty and often astonishing, is a vanguard.” — Slashfilm.com
“…the visual language of games will soon come to have as much of an impact on up-and-coming film directors as cinema does… and it’s safe to say that we won’t be short of films based on video game properties…With an increased push towards the home viewing experience in movies and interactivity in media, it will be interesting to see how the cinema of tomorrow is influenced by gaming perspectives. “ — Den of Geek
We will certainly see more of the first-person perspective, too. Some hailed the project as a technical marvel and “a revolutionary approach to narrative filmmaking.”
**How I tested the movie trailer
I run downloaded video clips through an application called the Harding Flash and Pattern Analyzer. (Graham Harding is one of the world’s leading experts on photosensitive epilepsy.) The FPA is widely used by producers and networks in the UK—including by the BBC—to reduce the risk of seizures from material on broadcast TV.
The analyzer examines video sequences frame by frame for very specific and measurable image qualities that researchers have found can trigger seizures. When such images are found, it displays and indicates the specific frames that violate seizure reduction guidelines. Violations occur with:
- rapidly alternating light and dark images (flash/flicker)
- certain stripes and geometric patterns with high contrast
- large areas of very bright (“saturated”) red
- problem images that take up more than one quarter of the total screen area
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Yes, video games and the reviews are “broken”
Posted: 02/26/2016 Filed under: Game Reviews, Media Coverage | Tags: computer games, flash, photosensitive epilepsy, seizures, video games Leave a comment
It’s no secret that the relationship between powerful game publishers and the press has a long history of conflict of interest. To stay in the good graces of game studios to ensure continued early, confidential access to forthcoming products, it’s in game reviewers’ interest–and the interest of the outlets where they write–to write favorable reviews.
Game critic Jason Evangelho stepped forward last week in Forbes to declare that both video games and the way they are reviewed by industry press are broken. He called on his colleagues in the reviewing business to stop running reviews that primarily serve their respective sites and the game publishers. “Remember who reviews are for,” he admonished. They’re for consumers who count on reviews to help them decide whether to spend their money on specific games.
Evangelho pointed out how reviewers are not doing their jobs properly: “…the gaming press is shielding your eyes from serious issues,” he wrote. “If we want fewer games to launch broken, we have to hold publishers accountable.” Jason admits he’s guilty of the reviewing practices he feels need to change. “I’m not perfect, but I’m trying my best to course-correct and do what’s right for the industry and especially for its consumers.” Jason, I so totally agree…even though you aren’t talking about the seizures that games can provoke.
What he’s really getting at
Jason’s particular beef is that publishers are increasingly releasing games before they’re fully functional, and that reviewers turn a blind eye to this practice. Reviewers don’t penalize incomplete products in their ratings but instead rate the game as though all the features are already in place. This is routinely done even performance suffers due to inadequate server capacity, or some features are still missing or aren’t working right at product release. Readers are then misled by reviews that give the publishers a “pass” on missing functionality.
He then calls on readers to speak out on the review process:
“If we want fewer games to launch broken, we have to hold publishers accountable. But that first step absolutely starts with me, and with my fellow critics in the game industry. And you need to tell us that’s what you want. Ultimately, the games and the coverage of games is done for you. So wield the power you have and make your voice heard.”
So, in a nutshell: studios should stop lifting the embargo the day before product release and should stop releasing games before they’re ready, news outlets should wait to run reviews until their reviewers can evaluate the same product version that users receive, reviewers should call out missing features and rate games accordingly, and users need to speak up about the status quo.
Kudos to Jason, especially for calling out the lack of candor by reviewers due to their focus on priorities other than their readers. Of course, in so doing, Jason’s piece brings to mind other ways that reviewers could help and advocate for their readers, if they chose.
Reviewers could alert consumers to games likely to provoke seizures, while signalling to publishers that this issue deserves their attention.
Tell reviewers you want them to assess games for seizure risk
If you agree that game reviewers should be more accountable to their readers, more responsible and more cognizant of their potential to influence publishers, then why not urge reviewers to address the seizure issue? It wasn’t what Jason was asking readers to do — but it’s all part of better serving readers. Certainly reviewers could influence the industry by writing about video game seizures and thereby holding publishers accountable.
I responded to the Forbes piece, commenting that consumer product reviews should address product safety issues. Here’s what I wrote (with a few minor edits):
Holding publishers responsible goes further than what you’ve described. Responsible reviewing for any consumer product should consider basic safety issues, and this has never been the case in video game reviews. We don’t expect consumers to test product safety, but in the case of video games, reviewers have left crash-safety testing to the consumer.
Many games expose consumers to a serious health hazard: seizures–many of them undetected— provoked by excessive flash, but game reviews fail to identify those games with a higher likelihood of inducing them. It would be very beneficial to readers if games were evaluated on this risk. Applications exist that scan images to find those with the potential to provoke seizures.
For more than 30 years game manufacturers have been acknowledging the seizure risk by routinely slapping a warning on their games. This protects the studios from legal action and allows them to continue producing images that can be a serious health threat. Including seizure risk in reviewers’ rating criteria would certainly encourage game developers to adhere to seizure reduction guidelines established for visual media.
Not every game contains image sequences that could provoke a seizure. But since all games carry the seizure warning, those consumers who know about the risk have no way to know before using/buying whether a particular game contains images likely to cause them a problem.
Regrettably, most consumers still have little awareness of the seizure risk from flashing graphics or that regardless of whether there’s a seizure history. People with this genetic vulnerability (photosensitive epilepsy) typically don’t realize they need to be cautious around particular visual stimuli, that is until they experience a seizure that’s noticeable enough to be identified. Most people don’t know—I certainly didn’t—that seizures don’t always look like a big event.
Seizures can go on for years before being identified. Certain populations—kids with ADHD or autism in particular—are at higher risk of seizures, and the symptoms caused by unidentified seizures in these kids can exacerbate and hide behind existing behavioral difficulties. Nobody is holding publishers accountable.
Perhaps the reviewing community will show some interest in the visual safety issue in the future…Anyone else want to weigh in with Jason on this? He’s reachable on Twitter and Facebook.
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Safe to play a game that passes the seizure test?
Posted: 01/17/2016 Filed under: Medical Research, Photosensitive Seizure Prevention, Results of safety testing, Seizure Risk, TV | Tags: computer games, flash, flicker, photosensitive epilepsy, photosensitivity, seizures, video games 4 Comments
Until now I’ve posted charts in this format to show whether a game meets photosensitive epilepsy guidelines…
According to a Reddit post, a game that I’ve said “passed the seizure test” triggered a seizure. Recently the same game—Hearthstone—could have been implicated in a professional gamer’s seizure that happened during a live stream. What’s going on?
I write about games I’ve tested to alert readers to the games that don’t meet internationally recognized image safety guidelines. But I don’t want to create undeserved confidence that a game that passed the seizure test will be safe for anyone with photosensitive epilepsy.
Ian Hamilton, a user interface designer who specializes in and advocates for game accessibility, clarifies the role of testing this way:
“Passing the Harding test doesn’t mean that a game is safe. It means ‘reasonably safe’ because common triggers have been avoided. Something that gets a ‘pass’ can still absolutely cause seizures.”
I regularly write that your experience may differ, that I’m not trained in quality assurance, that I test excerpts of game play, and that health and lifestyle variables affect every individual’s vulnerability to seizures at any given time. Still, the meaning of my findings could be misleading without an understanding of the limitations of the seizure test itself:
- the pass/fail guidelines aren’t expected to prevent seizures in all individuals
- the test was designed for TV images, not video games
What the Pass/Fail guidelines mean
The guidelines originated in 1994, when the UK’s agency for regulating TV broadcasting (now known as Ofcom) inserted into its code of standards some technical guidelines to accommodate viewers with photosensitive epilepsy. These guidelines, based on studies of photosensitive epilepsy and consultation with Prof. Graham Harding and other photosensitive epilepsy experts, detail flash rates and spatial patterns that typically trigger seizures in people with photosensitive epilepsy. Specifications regarding saturated red images were added later, after the 1997 Pokémon incident in Japan.
Some compromises in the guidelines were made for the sake of practicality. Criteria for acceptable images (commonly referred to as the Harding test) were developed with the understanding that they would realistically protect most individuals with photosensitive epilepsy, but not all. For example, the guidelines permit images that flash at a rate of up to 3 times per second because flash at that frequency affects only 3 percent of photosensitive individuals. UK regulators decided that was “an acceptably small risk.”
…but I’m updating all the charts by removing the word “safety” since passing the test doesn’t guarantee seizure safety.
The introduction to the guidelines states that their purpose is “reducing the risk of exposure to potentially harmful stimuli.” It also concedes that even when broadcasting images that comply with the guidelines,
“it is…impossible to eliminate the risk of television causing convulsions in viewers with photosensitive epilepsy.”
Applying TV guidelines to video games
There are no formal guidelines for reducing the seizure risk from video games. A 2005 consensus paper by experts on photosensitive seizures acknowledges that additional work would be required first on the existing guidelines for TV. In the meantime, it is reasonable to use the television guidelines since the impact of screen images on the visual system is the same.
The biggest challenge in applying TV specifications to video games is explained in the consensus paper:
“These principles are easier to apply in the case of fixed media (for example, a prerecorded TV show), which can be analyzed frame-by-frame. Interactive media, such as video games, may afford essentially limitless pathways through the game, depending on user actions. Therefore …in the case of video games, the consensus recommendations apply to typical pathways of play but cannot cover every eventuality of play.”**
Reducing risk going forward
In sum, a game that fails the Harding test is best avoided by those with photosensitive epilepsy. A game that passes is less likely to act as a trigger. Despite all the qualifiers, I believe there’s value in reminding people that seizures can happen to anybody, that certain video games can trigger them, and that you can lessen the risk by selecting games without lots of flash and patterns. Other strategies to lessen the risk of photosensitive seizures can be found here and here.
Tip of the hat to Ian, who suggested that I avoid the word “safe” when describing games that have passed the test. I also will be revising my prior posts to do some rewording.
Gamer’s seizure on live stream
Here’s a reminder that seizures can happen to anyone. A professional gamer known as Lothar had a seizure recently during his live feed while playing Hearthstone on Twitch. Lothar apparently has no history of seizures and the seizure may or may not have any connection to Hearthstone. In updates about his condition and hospital stay, Lothar didn’t mention photosensitive epilepsy nor has he said he’s been advised to limit his gameplay.
For the record, Lothar is also a body builder—he’s obviously a guy who has enjoyed good health and takes good care of himself. Lothar has a large and caring following and has been receiving lots of well wishes as he recovers. Why do I mention this incident here? Viewing the incident (you can find it on YouTube) and seeing how it affected so many fans who care about him reinforced for me the seriousness of seizures and the importance of preventing those that are preventable.
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CNET endorses 7 video games that can trigger seizures
Posted: 12/20/2015 Filed under: Results of safety testing | Tags: computer games, epilepsy, flash, flicker, photosensitive epilepsy, seizures, video games 2 Comments
Uncharted: The Nathan Drake Collection is the only one of CNET’s recommended games that didn’t fail the seizure test.
Wouldn’t it feel terrible to give someone a present that could set off an epileptic seizure? If you consult the CNET guide to video games for 2015 holiday giving, you’ve got 8 games to choose from–of which 7 contain seizure-inducing images. In the 3+ years that I’ve been testing selected video games for seizure-provoking graphics, this is easily the most lopsided result I’ve found.
The following table shows the games recommended in CNET’s “The best video games to give this holiday season” feature, with results of testing them for image sequences capable of triggering seizures. Testing is done with an application designed for this specific purpose (more info on that is below in the testing methdology section).
CNET’s choices for best video games to give this holiday season
Interpreting the results
Passing the seizure guidelines test means that in the 1.5+ hours of gameplay and cutscenes I tested, all image sequences meet well-defined guidelines for reducing visually induced seizures. I am not set up to test every possible sequence (video game developers should be able to do this, though). To get a “fail” on my tests, all that’s needed is one violation of the guidelines, which could occur within the space of a second or two. Again, since I do not test every possible sequence, it’s very possible–and likely–that the game also has other problem images that I didn’t test.
Your results may be different. Each person’s seizure threshold can be affected by a number of factors apart from the visual stimulus itself: illness, hunger, stress, fatigue, alcohol, medications, length of play, and others. So a game played without incident may trigger a seizure in the same player under different conditions. Also, players can be exposed to new and different image sequences in subsequent games.
CNET selected conventional action/adventure titles for its gift-giving guide. These games typically have plenty of shooting, explosions, and rapid movements that produce flicker in the seizure-inducing range of more than 3 flashes per second. In contrast, recent video game recommendations from both the New York Times and Los Angeles Times, with less tech-focused audiences, added some unconventional titles to their top picks. It’s worth noting that the less traditional games were less likely to fail the seizure test.
Uncharted: The Nathan Drake Collection–the one game CNET chose that meets the seizure reduction guidelines–is an action/adventure game, too, with some shooting and the occasional explosion, but designed without flickering images or other visual overload.
Images in Uncharted: The Nathan Drake Collection show explosions yet stay within seizure prevention guidelines.
Why it matters
Nobody wants to think about the risk of seizures that can be triggered by video games, figuring they’re extremely rare (they aren’t) and that the risk only applies to “people with epilepsy” (not so). Also, people assume that seizures are always of the grand mal type, with loss of consciousness, lots of involuntary movements, etc., so that they would be very obvious events (most seizures are not like this).
If you assume seizures are very obvious, then you also assume you’d hear a lot more about seizures that happen in front of computer screens and consoles. But many seizures are much more subtle, some so subtle that nobody realizes they’re happening. Even in these instances, though, the after-effects may mean impaired functioning for up to several days, or longer, affecting energy, concentration, memory, sleep, and mood. You can read here about how game-induced seizures we couldn’t see affected my daughter.
Vulnerability to seizures from bright flashes and rapid flicker, known as photosensitive epilepsy, is a genetic trait that’s latent in an unknown percentage of the population. This means that there are people with no idea they have this sensitivity to visual stimuli–until they are triggered and experience a noticeable seizure. So these people assume the seizure warnings accompanying video games don’t apply to them, or they just ignore them.
Testing tool and methodology
I run downloaded gameplay clips, cinematic clips, and promotional trailers for each game and submit the sequences to an application called the Harding Flash and Pattern Analyzer. (Graham Harding is one of the world’s leading experts on photosensitive epilepsy.) The FPA is widely used by producers and networks in the UK—including by the BBC—to reduce the risk of seizures from material on broadcast TV. I don’t know how many of the major game developers in this country use the FPA–they keep such information very much to themselves.
The analyzer examines video sequences for very specific and measurable image qualities that researchers have found can trigger seizures:
- rapidly alternating light and dark images (flash/flicker)
- certain stripes and geometric patterns with high contrast
- large areas of very bright (“saturated”) red
- problem images take up more than one quarter of the total screen area
If the first clip I test of a game fails the seizure guidelines test, I then move on to test the next game. If no guideline violations are found, I typically test at least 4 or 5 additional clips of that game–usually more, if I have a hunch due to the game genre and/or overall look of the sequences that there might be unsafe “footage” that I haven’t yet found. Most image sequences that fail the test do so because of strobe-like flicker.
Games that pass could have seizure-provoking sequences that I was unable to locate. I don’t do this testing while actually playing video games. Instead I work with video clips available online, some of which are official marketing and gameplay trailers; others are cutscenes and gameplay sessions posted by reviewers or fans. I avoid testing any clips of gameplay that were made using modifications to the original game software.
Other games I tested in 2015
This year I’ve tested also tested some other highly praised video games for their seizure risk (plus the games recommended by the New York Times and Los Angeles Times as noted above). Those results are here and here.
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LA Times’ best video games of 2015: 4 can trigger seizures–and that’s progress
Posted: 12/14/2015 Filed under: Results of safety testing | Tags: computer games, epilepsy, flash, flicker, photosensitive epilepsy, seizures, video games 2 Comments
In the game Prune, players help trees grow.
The Los Angeles Times’ list of 10 best video games of 2015 includes 4 with images that could provoke a seizure. While this isn’t great, it’s not as bad a ratio as I typically find. Usually the best of year/best of show lists contain a higher percentage of games with a real seizure risk, so this is actually better than I expected.
The Times reviewer, Todd Martens, noted that this year there was a broader selection of games and they offered a wide range of player experiences and perspectives. And a number of his favorites are refreshingly novel in their imagery.
Martens writes about his choices in an accompanying piece entitled “Games in 2015 were better when they stepped away from the guns.”
“For a medium that for much of the last decade has been overrun with machismo, 2015 in video games represented a year of powerful role reversals. It was time, finally, to put down the guns… At a time, culturally, when mass shootings are part of our daily conversation, the industry’s over-reliance on games with guns is not only no longer fun, it’s exhausting.
The idea of swapping weapons for actual stories should be celebrated in any medium, but in gaming, where guns, bullets and senseless bloody murder have long ruled the day, it felt downright revolutionary.”
So here’s another reason to celebrate the appearance of appealing games that don’t rely on guns: without the widespread shooting, mayhem, and destruction that have dominated in many top-selling games, there are fewer scenes with flicker and flash that can provoke seizures. (It is quite possible, though, to depict such scenes without creating large, rapid, and bright flashes on the screen.)
I tested clips from the Los Angeles Times Top Ten list using an application that detects image sequences that can trigger seizures in vulnerable individuals. If you’re still doing holiday shopping, you might want to consider these results when choosing gifts. Here’s what I got:
Best video games of 2015 chosen by the Los Angeles Times
Disclaimers
Please remember that there are no guarantees your results will match mine and that many variables affect a person’s susceptibility to visually induced seizures. Each person’s seizure threshold can be affected by a number of factors apart from the visual stimulus itself: illness, hunger, stress, fatigue, alcohol, medications, length of play, and others. So a game played without incident may trigger a seizure in the same player under different conditions. Also, players can be exposed to new and different image sequences in subsequent games.
Testing methodology
I run downloaded gameplay clips, cinematic clips, and promotional trailers for each game and submit the sequences to an application called the Harding Flash and Pattern Analyzer. The FPA is widely used by producers and networks in the UK—including by the BBC—to reduce the risk of seizures from material on broadcast TV. I don’t know how many of the major game developers in this country use the FPA–they keep such information very much to themselves.
The analyzer examines video sequences for very specific and measurable image qualities that researchers have found can trigger seizures:
- rapidly alternating light and dark images (flash/flicker)
- certain stripes and geometric patterns with high contrast
- large areas of very bright (“saturated”) red
- problem images take up more than one quarter of the total screen area
If the first clip I test of a game fails the seizure guidelines test, I then move on to test the next game. If no guidelines violations are found, I typically test at least 4 or 5 additional clips of that game–sometimes more, if I have a hunch due to the game genre and/or overall look of the sequences that there might be problem “footage” that I haven’t yet found.
Games receiving a PASS could have seizure-provoking sequences that I was unable to locate. I don’t do this testing while actually playing video games. Instead I work with video clips available online, some of which are official marketing and gameplay trailers; others are cutscenes and gameplay sessions posted by reviewers or fans. I avoid testing any clips of gameplay that were made using modifications to the original game software.
Other games tested in 2015
I’ve tested additional video games this year for their seizure risk. You can find results here, here, and here.
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Seizure-inducing images found in 6 video games in New York Times holiday gift guide
Posted: 12/07/2015 Filed under: Results of safety testing | Tags: computer games, epilepsy, flash, flicker, photosensitive epilepsy, seizures, video games 2 Comments
When choosing a video game for someone on your holiday gift list (or for yourself), wouldn’t it be good to know whether the game contains images that could trigger a seizure? The seizures caused by certain video game visuals are a health risk that most people don’t stop to consider.
They’re also more common than people realize.
So at this time of year I like to provide some guidance on seizure likelihood in the games you might be thinking of buying. I test the games recommended in holiday gift guides, looking for the types of image sequences that can provoke seizures.
Today I’m reporting on the 10 video games suggested as gifts this year by the New York Times. Take a look at the introduction to the video games section of the guide.
“Buying someone a new video game can be a little like sending a family member on an unexpected foreign trip. It’s a nice gesture, and will surely be appreciated, but it’s awfully hard to know whether you’ve picked the right destination….Here are a few places to consider taking yourself, or your loved ones, on vacation this winter.”
— New York Times 2015 Holiday Gift Guide
There’s no hint in the prose above that the “right destination” could involve more than the entertainment value of the game. The narrative reads as though the worst possible consequence of your buying choice could be a less-than-totally-fun game experience. The “right destination” stakes actually are much higher for some people, since seizures are pretty serious business.
How to know the level of risk
- There is no practical way for consumers to know in advance whether a given video game contains the types of flashing and pattern movements that can provoke seizures. Games are rated for mature content and violence but not for seizure risk. One obvious clue, sometimes provided by the game studios, is the presence of lots of quick flashes in the promotional trailer.
- Visually provoked seizures can happen in individuals with no history of seizures.
- There is no way to know whether an individual might be at risk for visually induced seizures. They may not have encountered the specific visual provocation that leads to a seizure. Or they may have had a seizure while playing, without realizing it.
- Seizures can be hard to identify–many are very subtle and don’t involved falling down or lots of movement. Even subtle seizures, though, can be followed by significant impairments: difficulties with concentration and disruption of emotional control and sleep patterns.
Which games in the Times gift guide appear to be OK?
Using software that analyzes visual sequences for the types of rapidly flashing images and moving patterns that can produce seizures, I tested the 10 games recommended by the Times buying guide. Incidentally, this software is intended for developers, not for folks like you and me–it allows them, should they opt to use it–to deliver a safer consumer product. This chart shows the results:
Recommended games from the 2015 New York Times holiday gift guide
I’ll get to the details in just a bit of how I do the testing—there is no way I can test anywhere near all the scenes and story lines in a game. I’m not a one-person quality assurance department! Basically, after looking at and submitting multiple clips of a given game to an analysis tool designed for detecting seizure-inducing images, I eventually either find material that poses a seizure risk, or determine that further testing won’t uncover any.
Please remember that there are no guarantees your results will match mine and that many variables affect a person’s susceptibility to visually induced seizures.
Testing methodology
I run downloaded gameplay clips, cinematic clips, and promotional trailers for each game and submit the sequences to an application called the Harding Flash and Pattern Analyzer. The FPA is widely used by producers and networks in the UK—including by the BBC—to reduce the risk of seizures from material on broadcast TV. I don’t know how many of the major game developers in this country use the FPA–they keep such information very much to themselves.
The analyzer examines video sequences for very specific and measurable image qualities that researchers have found can trigger seizures:
- rapidly alternating light and dark images (flash/flicker)
- certain stripes and geometric patterns with high contrast
- large areas of very bright (“saturated”) red
- problem images take up more than one quarter of the total screen area
If the first clip I test of a game fails the safety test, I note that and move on to test the next game. If no safety violations are found, I typically test at least 4 or 5 additional clips of that game–sometimes more, if I have a hunch due to the game genre and/or overall look of the sequences that there might be unsafe “footage” that I haven’t yet found.
Games I’ve listed as safe could have seizure-provoking sequences that I was unable to locate. I don’t do this testing while actually playing video games. Instead I work with video clips available online, some of which are official marketing and gameplay trailers; others are cutscenes and gameplay sessions posted by reviewers or fans. I avoid testing any clips of gameplay from modified game software.
Disclaimers
Each person’s seizure threshold can be affected by a number of factors apart from the visual stimulus itself, including illness, hunger, stress, fatigue, alcohol, medications, length of play, and the player’s menstrual cycle, among others. So a game that ordinarily seems OK may trigger a seizure in that same player under different conditions.
Other games tested in 2015
Holiday buying/year-end isn’t the only season for seizure guidelines compliance testing. I’ve tested additional titles this year. You can find results here and here. Also here.
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Pediatricians should push for fewer seizures!
Posted: 11/17/2015 Filed under: Medical Research, Political Action & Advocacy | Tags: ADHD, American Academy of Pediatrics, autism, computer games, epilepsy advocacy, flash, flicker, photosensitive epilepsy, seizures, video games Leave a comment
The pediatricians of this country, working with the American Academy of Pediatrics, are in a position to help reduce the continuing public health risk of video games and other media that can induce seizures. They should lobby the entertainment industry — something they already apparently do regarding other media matters — to produce games without seizure-inducing images.
As I’ve written previously, the AAP is rethinking its policy on media use by young children. Now it’s clear why: the American Academy of Pediatrics’ Council on Communications and Media published new data this month on media use by very young children. According to the study, there is “almost universal exposure to mobile devices, and most had their own device by age 4.”
The media landscape has changed significantly since the AAP drafted its 2011 policy statement discouraging media use in children under age 2. Mobile ownership has increased sharply–the authors note that tablets weren’t available yet when the 2011 recommendations were written.
As part of its updated policy statement on media use, the Academy will issue revised advocacy and research objectives. How about advocating for electronic entertainment that doesn’t provoke seizures?
AAP’s current advocacy priorities on kids and media
The AAP’s Council on Communications and Media policy statement on media use from November 2013 contains a variety of advocacy recommendations, including proposals that pediatricians and the AAP:
- Advocate for a federal report within the National Institutes of Health or the Institute of Medicine on the impact of media on children and adolescents
- Encourage the entertainment industry to “reassess the effects of their current programming”
- Establish an ongoing funding mechanism for new media research
- Challenge the entertainment industry to make movies without portrayals of smoking and without product placements
Proposed changes to above initiatives
Here’s how these points should be expanded to encompass the health risk to unknown numbers of children who experience seizures from flashing visuals:
- Advocate for a federal report within the National Institutes of Health or the Institute of Medicine on the impact of media on children and adolescents, including the neurological impact of flashing screens
- Encourage the entertainment industry to “reassess the effects of their current programming” – including the physiological effects of flashing and high-contrast patterns
- Establish an ongoing funding mechanism for new media research that includes studies on the vulnerability of young people with ADHD, autism spectrum disorders, and mood disorders
- Challenge the entertainment industry to make movies without portrayals of characters smoking and without product placements and to make video games without the flashing and pattern characteristics that can trigger seizures
Question for the AAP Council on Communications and Media
There are many angles and interests that must be considered in making your next policy statement. I have a lot to add to the conversation as far as reducing the risks to young people of screen-triggered seizures, many of which go undetected. Would you accept my assistance? I would be happy to help.
Seizures from Video Games 
