Graf W D, Chatrian G E, Glass S T, Knauss T A
Department of Pediatrics, Children's Hospital and Medical Center, Seattle, WA 98105.
Pediatrics. 1994 Apr;93(4):551-6.
To further describe the features, postulated pathophysiology, treatment, and outcome of seizures occurring while playing or watching video games (video game-related seizures (VGRS)).
We evaluated retrospectively 10 patients with VGRS seen by us and reviewed 25 reported cases.
The 35 patients ranged in age from 1 to 36 years (mean: 13.2); and 26 subjects (74%) were male. Eight individuals (29%) had prior infrequent nonfebrile seizures, 4 (11%) had febrile convulsions, and 2 (6%) had a family history of epilepsy. VGRS consisted of generalized tonic-clonic seizures in 22 of 35 individuals (63%); absences in 2 (6%); simple partial seizures in 6 (19%); complex partial seizures in 4 (11%); and other manifestations in 4. Neurologic examination and computed tomographic and magnetic resonance imaging scans were normal. Electroencephalograms demonstrated generalized or focal, interictal or ictal epileptic patterns in 11 of 21 patients (52%) and photoparoxysmal responses in 17 of 32 (53%). Eleven of 15 individuals (73%) treated with video game (VG) abstinence alone, 3 of 6 who received anticonvulsants but played VGs, and 7 of 12 treated with combined VG abstinence and anticonvulsants had no further seizures.
We postulate that a special convulsive susceptibility of selected neurons in striate, peristriate, infratemporal, and posterior parietal cortices to particular visual stimuli plays a major role in VGRS. VG abstinence is the treatment of choice of VGRS. Anticonvulsant medication is suggested only for those individuals who continue to play VGs or suffer from seizures triggered by other, unavoidable visual stimuli, or from unprovoked attacks.
进一步描述在玩或观看电子游戏时发生的癫痫发作（与电子游戏相关的癫痫发作[VGRS]）的特征、推测的病理生理学、治疗及预后。
我们对我们诊治的10例VGRS患者进行了回顾性评估，并复习了25例已报道的病例。
35例患者年龄在1至36岁之间（平均：13.2岁）；26例（74%）为男性。8例（29%）既往有偶发的非热性癫痫发作，4例（11%）有热性惊厥，2例（6%）有癫痫家族史。35例患者中，22例（63%）的VGRS表现为全身强直阵挛发作；2例（6%）为失神发作；6例（19%）为简单部分性发作；4例（11%）为复杂部分性发作；4例有其他表现。神经系统检查以及计算机断层扫描和磁共振成像扫描均正常。21例患者中的11例（52%）脑电图显示有全身性或局灶性、发作间期或发作期癫痫样放电，32例中的17例（53%）有光阵发性反应。仅采用戒除电子游戏治疗的15例患者中有11例（73%）、接受抗惊厥药物治疗但仍玩电子游戏的6例患者中有3例、采用戒除电子游戏与抗惊厥药物联合治疗的12例患者中有7例未再发作。
我们推测，纹状皮质、纹周皮质、颞下皮质和顶叶后皮质中特定神经元对特定视觉刺激的特殊惊厥易感性在VGRS中起主要作用。戒除电子游戏是VGRS的首选治疗方法。仅建议对那些继续玩电子游戏或因其他不可避免的视觉刺激引发癫痫发作或有自发发作的个体使用抗惊厥药物。
