urban myth and epilepsy

URBAN MYTH and URBAN MYTH and EPILEPSYEPILEPSY

Enrique Feoli MDEnrique Feoli MDNorth East Regional Epilepsy groupNorth East Regional Epilepsy group

““Sacred Disease”Sacred Disease”The disease with the thousand namesThe disease with the thousand names

HistoryBabylon, people that suffer from epilepsy

were felt to possessed by a demon.Asia and China, 8th Century medical

manuscript refer to “Xian” falling sickness.India, has one of the oldest medical

systems ever recorded. “Apasmara”, was the word use to describe epilepsy.

““Sacred Disease”Sacred Disease”The disease with the thousand namesThe disease with the thousand names

Roman Empire, the blood or liver of gladiators killed in the Roman games should be consumed as a remedy for epilepsy.

Seizures MythsSeizures Myths

• If the person who sees the spasm, first urinates in his shoe, tips it back and forth and then gives the patient the urine to drink, the seizure will stop immediately.

Antonius Guainerius, 1440


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

Before 1920


morbus scelestis (Lat.: the accursed disease, the wicked disease) People with epilepsy were often regarded to have been deserted or punished by God.


• Cut a black pigeon or a black hen through the middle, put it onto the head of the child with epilepsy and then give it to a dog to eat.

(Folk tradition, source unknown)

1515thth Century Century

• Image taken from the first medical textbook "Cerrahiyyet'ül Haniyye", written in Ottoman language by the Turkish surgeon Serafettin Sabuncuoglu.

• From the Ancient World to the Middle Ages, cauterizations were also used in the treatment of epilepsy.

• Raphael

(1483-1530)

Transfiguration of Christ

EpilepsyEpilepsy

Hippocrates recognized that epilepsy as an organic process of the brain.

J.H. Jackson 19th century, formulated the modern definition of epilepsy

“ A occasional excessive and disorderly discharge of nerve tissue”

EpilepsyEpilepsy

Current TimesHaiti; epilepsy is still considered to be the

result of possession by “loas”Africa; some tribes believe that epilepsy is

contagious.1999 Hungary 415 patients 65% consulted

with religious figures during the course of their disease.

EpilepsyEpilepsy

Seizures: transient occurrence of signs and symptoms due to and abnormal excessive neuronal activity in the brain.

Epilepsy: is a disorder of the brain characterized by two or more unprovoked seizures.

EpilepsyEpilepsy

Seizure Disorder

Coughing Disorder; Asthma

Diarrhea Disorder; gastroenteritis

Supplement for seizuresSupplement for seizures

AES meeting in New Orleans, University of California at San Francisco showed that;

187 patients 56 % used alternative medicines 68% Let their physicians know 15 % took something that could make

seizures worse 15% took something that could interfere

with AED’s

Supplement for seizuresSupplement for seizures

GinsengGingko May exacerbate SzEvening primrose

GingkoSt John’s Wort Induce liver MetabolismEchinacea Garlique

Swallowing the TongueSwallowing the Tongue

“The myth that someone having a seizure may swallow his tongue is physically impossible. Because of this myth, people tend to do more harm than good by trying to force something in the mouth of the person having a seizure to hold his tongue down”

Photic Stimulation, video Games Photic Stimulation, video Games and Epilepsyand Epilepsy

1885 Gowers described Abnormal EEG in a girl who had seizures going into bright sunshine.

Seizures due to TV content 1980’s Captain Powers, induce a seizure in a

young man 1993 an advertisement for “Golden Wonder, Pot

Noodle” in UK induced 3 seizures in the first showing.

Pokemon Incident Pokemon Incident An unplanned Experiment in NatureAn unplanned Experiment in Nature

Pokemon incident in Japan Most Dramatic December 16, 1997. A rocket launch sequence of flashing red and

blue lights changing at 12.5 sec for 4 sec. was shown on Tokyo TV.

685 children went to the hospital 560 of this children had seizures Rest had migraines, nausea, motion sickness.

Pokemon Incident Pokemon Incident An unplanned Experiment in NatureAn unplanned Experiment in Nature

Warning Cover one eye

pokemon.flv

Pokemon IncidentPokemon Incident

75 % of the children did not have epilepsy

Given that 7 million children were watching the program, this suggests that 1 in 10,000 had a seizure in response to photic stimulation.

Only 24% who had a seizure during the cartoon had previously experienced a seizure

Photic- and Pattern-induced Seizures: A Review for the Epilepsy Foundation of Photic- and Pattern-induced Seizures: A Review for the Epilepsy Foundation of

America Working GroupAmerica Working Group*Robert S. Fisher, †Graham Harding, ‡Giuseppe Erba, §Gregory L. *Robert S. Fisher, †Graham Harding, ‡Giuseppe Erba, §Gregory L. Barkley, and Arnold Wilkins Barkley, and Arnold Wilkins EpilepsiaEpilepsia

Volume 46 Page 1426 - September 2005Volume 46 Page 1426 - September 20051167.2005.31405.xVolume 46 Issue 91167.2005.31405.xVolume 46 Issue 9

Summary: Purpose: This report summarizes background material presented to a consensus conference on visually provoked seizures, convened by the Epilepsy Foundation of America.

Methods: A comprehensive review of literature was performed.Results: Photosensitivity, an abnormal EEG response to light or pattern stimulation,

occurs in 0.3–3% of the population. The estimated prevalence of seizures from light stimuli is 1 per 10,000, or 1 per 4,000 individuals age 5–24 years. People with epilepsy have a 2–14% chance of having seizures precipitated by light or pattern. In the Pokemon cartoon incident in Japan, 685 children visited a hospital in reaction to red–blue flashes on broadcast television (TV). Only 24% who had a seizure during the cartoon had previously experienced a seizure. Photic or pattern stimulation can provoke seizures in predisposed individuals, but such stimulation is not known to increase the chance of subsequent epilepsy. Intensities of 0.2–1.5 million candlepower are in the range to trigger seizures. Frequencies of 15–25 Hz are most provocative, but the range is 1–65 Hz. Light–dark borders can induce pattern-sensitive seizures, and red color also is a factor. Seizures can be provoked by certain TV shows, movie screen images, video games, natural stimuli (e.g, sun on water), public displays, and many other sources.

Conclusions: Recommendations on reducing risk of seizures have been developed by agencies in the United Kingdom, Japan, and the International Telecommunications Union, affiliated with the United Nations. The Epilepsy Foundation of America has developed a consensus of medical experts and scientists on this subject, reported in an accompanying work.


Photic Induced Seizures: a seizure provoked by visual stimulation.

Photoparoxysmal response, an abnormal EEG response to light or pattern, consisting of spikes, spike waves or slow waves, should not be confined to the occipital region, should not be confused with photic driving.

Television US vs UKTelevision US vs UK

USA and Japan (NTSC) TV screens scan at 60HZ

Europe (PAL standard, phase alternating line) scans at 50 HZ

Stimulation at 50Hz produces PPR in 49% of photosensitive patients

Stimulation at 60Hz produces PPR in 15% of them.


OTHER FACTORSVisual AcuityAmbient lightContentBrightness of the screenAmong others


Video Display UnitsShould be less likely than TV to provoke

seizuresTend to be smaller Less brightRefresh at 70Hz

Video GamesVideo Games

1981 The Lancet “space invader epilepsy” 1981 Jeavons (UK) Seizure by a hand held

video game. 1983 Dahlquist (USA) first US video game sz

report 1991 Nintendo starts putting warning on games. 1992 UK a child died following a seizure

induced by video game. 1994 Ferrie, 35 cases, coined the term video

game epilepsy


Ricci and Vigevano Study

European Video-Game study

Video GamesVideo GamesMisnomersMisnomers

Video Game Epilepsy

Photic Induced Epilepsy


Some patients with a predisposition towards epilepsy might have their first seizure while playing a video game, but this does not mean that the video game cased epilepsy.


Screening devices are difficult for video games.

Video Games posses a minor risk for patients with no known photosensitivity.


Can Individuals with epilepsy, but with no known ABN EEF induce by pthotic stimulation safely play a video game?

Millet and colleagues 1999 212 patients, with Epilepsy no EEG photic or

pattern sensitivity Randomly assigned to a video game or leisure

activity. Then crossover End point clinical seizure


25 seizures 13 during video game, 12 during other activities.

ANSWER IS

Patients with Epilepsy with no know photoparoxysmal sensitivity MAY SAFELY play video games.

TV RECOMMENDATIONSTV RECOMMENDATIONS

View TV from > 8 feetView in a well-lit room, with a small lamp

on top of the TV set.Do Not approach the TV to switch

channels.Cover one eye if it is necessary to go near

the TVWear polarized glasses on sunny days to

reduce flickering reflection from water.

Video Game RecommendationsVideo Game Recommendations

While playing video games the screen should be less than 12 inches or the patient should sit more than 4 times the diagonal diameter from the screen.

Play for more than 1 hour should be avoided, and sleep should be maintained.

People with hx or family history of photosensitivity should have an EEG examination with photic stimulation before playing video games.

Recreational Activity and EpilepsyRecreational Activity and Epilepsy

“Persons with epilepsy are often excluded or discouraged from participation is sports and recreational activities because of fear of what might occur during the activity”

Athletics and EpilepsyAthletics and Epilepsy

It is an Individual decision

Exercise provoked seizuresExercise provoked seizures

True or False

The data is limited, but there is no prove that sports participation provokes seizure recurrence. (Sports Medicine 1999;10:9-19)

urban myth and epilepsy

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