Mah-jong--Induced Seizures

An
article in the Honk Kong Medical Journal reports on a seried of cases
of Mah-jong Epilepsy.  This is something I had not heard of
before: it is considered a subtype of cognition-induced epilepsy.

rev="review" href="http://www.hkmj.org/abstracts/v13n4/314.htm">Mah-jong-induced
seizures: case reports and review of twenty-three patients

Richard SK Chang, Raymond TF Cheung, SL Ho, Windsor Mak

Department of Medicine, Queen Mary Hospital, Hong Kong

Hong Kong Med J 2007;13:314-8



'Mah-jong epilepsy' is a rare reflex epilepsy syndrome, manifesting as
recurrent epileptic seizures triggered by either playing or just
watching mah-jong. We present three patients with this condition and
review all the reported cases. Mah-jong-induced seizures can be
considered a subtype of cognition-induced epilepsy. Nonetheless, these
patients have distinctive clinical and electrophysiological features:
late age of onset, different seizure patterns, single seizure-trigger,
lack of spontaneous seizures, and electroencephalographic findings not
supportive of idiopathic generalised epilepsy. The pathophysiological
mechanism underlying mah-jong-induced seizures may be different from
the other cognition-associated reflex epileptic phenomena.

The open-access PDF is href="http://www.hkmj.org/article_pdfs/hkm0708p314.pdf">here.
 There is also something called href="http://www.neurology.org/cgi/content/abstract/66/5/723"
rel="tag">drawing-induced epilepsy and epilepsy
associated with specific emotional states...
 

The
latter was of particular interest to me.  The case
report,  Cognition-induced epilepsy associated with
specific emotional precipitants, describes a case of what had
been thought to be (psychogenic) pseudoseizures.  They
occurred whenever she talked about early experiences with child abuse.
 Video plus EEG monitoring revealed that true absence seizures
were occurring.

rev="review"
href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WDT-4KJ0SSV-3&_user=99318&_coverDate=09%2F30%2F2006&_rdoc=21&_fmt=summary&_orig=browse&_srch=doc-info%28%23toc%236775%232006%23999909997%23631482%23FLA%23display%23Volume%29&_cdi=6775&_sort=d&_docanchor=&view=c&_ct=25&_acct=C000007678&_version=1&_urlVersion=0&_userid=99318&md5=69ad8dbdf1409471e24ba92dd55825b4">Cognition-induced
epilepsy associated with specific emotional precipitants

Rebekah J. Woods and Michael Gruenthal

Department of Neurology, University of Louisville, Louisville, KY, USA

Received 12 June 2006;  accepted 19 June 2006. 
Available online 31 July 2006.



Abstract



A 32-year-old woman with primary generalized epilepsy described absence
events precipitated by talking about childhood sexual abuse, her
epilepsy, or her father's difficulties with schizophrenia. She was
referred for assessment of suspected psychogenic nonepileptic events.
During simultaneous video/EEG monitoring, 30 absence seizures were
recorded, 28 of which occurred while discussing one of these three
specific precipitants. No nonepileptic events were seen. This finding
highlights the importance of thorough investigation of ambiguous
events, and confirms that specific emotional precipitants can induce
seizures in susceptible people with epilepsy.  

I sometimes have been ambivalent about ordering imaging or EEG on
patients with odd experiences, but every once in a while, something
important turns up.