PURPOSE: To describe the recent epidemic of photosensitive seizure that occurred in relation to an episode of the television animation program "Pocket Monsters," we report four patients who experienced seizures while watching the episode in question. We also report some technical aspects of the program episode. METHODS: We investigated the clinical symptoms of the four patients and performed routine EEGs with intermittent photic stimulation (IPS). If IPS provoked no photoparoxysmal response (PPR) during the routine EEG examination, a second EEG was performed with the photic stimulator placed 10 cm from the patient's eyes. In addition, we reviewed the "Pocket Monsters" episode, focusing our attention on the visual techniques used with reference to the Independent Television Commission (ITC) guidelines. RESULTS: One patient who had myoclonic jerks before the convulsion in question was diagnosed as having juvenile myoclonic epilepsy, and the diagnosis of another patient was pure photosensitive epilepsy. The remaining two patients had their first seizures, which could be occasional seizures, and we therefore could not reach a diagnosis of epilepsy. In our four patients, only one showed PPR on the routine EEG. Two patients revealed PPR on the second EEG, and the remaining patient showed no PPR. Rapid changes in color are believed to be responsible for the photosensitive seizures because all four patients had seizures at around 18:50, when seconds of deep red and bright blue flashes, alternating at a frequency of 12 Hz, were shown. CONCLUSIONS: Regulations for technical aspects of children's programming, including the use of colors, are urgently needed in Japan to prevent a repeated incident. In addition, the IPS procedure needs to be standardized, especially for patients who are suspected to have photosensitivity.
PURPOSE: To describe the recent epidemic of photosensitive seizure that occurred in relation to an episode of the television animation program "Pocket Monsters," we report four patients who experienced seizures while watching the episode in question. We also report some technical aspects of the program episode. METHODS: We investigated the clinical symptoms of the four patients and performed routine EEGs with intermittent photic stimulation (IPS). If IPS provoked no photoparoxysmal response (PPR) during the routine EEG examination, a second EEG was performed with the photic stimulator placed 10 cm from the patient's eyes. In addition, we reviewed the "Pocket Monsters" episode, focusing our attention on the visual techniques used with reference to the Independent Television Commission (ITC) guidelines. RESULTS: One patient who had myoclonic jerks before the convulsion in question was diagnosed as having juvenile myoclonic epilepsy, and the diagnosis of another patient was pure photosensitive epilepsy. The remaining two patients had their first seizures, which could be occasional seizures, and we therefore could not reach a diagnosis of epilepsy. In our four patients, only one showed PPR on the routine EEG. Two patients revealed PPR on the second EEG, and the remaining patient showed no PPR. Rapid changes in color are believed to be responsible for the photosensitive seizures because all four patients had seizures at around 18:50, when seconds of deep red and bright blue flashes, alternating at a frequency of 12 Hz, were shown. CONCLUSIONS: Regulations for technical aspects of children's programming, including the use of colors, are urgently needed in Japan to prevent a repeated incident. In addition, the IPS procedure needs to be standardized, especially for patients who are suspected to have photosensitivity.