Four months ago, Fang, a 52-year-old Chinese man, collapsed when he was playing mahjong with his friends. His body was stiffening and shaking. His eyes were rolling back and he was foaming at the mouth. It lasted for around two minutes before Fang was immediately rushed to the hospital. Nevertheless, the hospital doctors were unable to identify the cause of his epileptic event.

Unfortunately, it was not a single incident for Fang. When he played mahjong again upon his recovery, he suffered from the same fate. Eventually, Fang sought help from Dr Ye-Lei Tang, consultant at the Neurology Department of the Second Affiliated Hospital of Zhejiang University School of Medicine. Fang was later diagnosed with a rare form of reflex epilepsy syndrome – the mahjong epilepsy.

Mahjong epilepsy: Seizure from the mahjong tiles?

Mahjong epilepsy is a rare reflex epilepsy syndrome which manifests as a recurrent seizures triggered by either playing or watching the game. This unique syndrome was first documented by a team of doctors from Hong Kong’s Queen Mary Hospital. 

The study identified 23 cases of people who suffered from mahjong epilepsy – all of which suffered from an epileptic event whilst playing or watching the game. The syndrome seems to affect far more men than women, and the average age is 54.

Duration did not affect the risk of developing an attack as individuals were vulnerable anytime between one and 11 hours into playing the game. In addition, the team ruled out other possibilities such as sleep deprivation or gambling stress as the contributing factor to each epileptic event.

Of all the 23 cases studied, almost all the patients suffered from general tonic-clonic seizures (GTCS) which affects the entire body causing the muscles to tense up and spasm.

According to Tang, certain individuals are particularly sensitive to dotted patterns on a white background which may trigger a reflexive form of epilepsy. Such can be seen in mahjong rather commonly as there are several tiles which feature dots in various quantities. In certain combinations, these dots can trigger an epileptic event in particularly susceptible individuals such as Fang. As such, Fang was advised to stay away from mahjong and observe if the epileptic events recur under the absence of mahjong. Fang has since stopped playing mahjong and has not suffered any further attacks so far.

The distinctive patterns of the mahjong tiles may trigger a rare reflex epilepsy syndrome.
The distinctive patterns of the mahjong tiles may trigger a rare reflex epilepsy syndrome.

The team of doctors has also suggested that the distinctive patterns of the mahjong tiles and the sound of the tiles crashing onto the table as contributory mechanisms that trigger the epileptic event. Although the mechanism of mahjong epilepsy remains uncertain at this point, it is widely understood that mahjong is the trigger of the unfortunate events. As such, patients with mahjong epilepsy are advised to avoid playing or watching mahjong entirely.

Case study examples

Here are a few examples of mahjong epilepsy documented in the study published in the Hong Kong Medical Journal:

1. In 1999, a 79-year-old man suffers from a GTCS after playing mahjong for eight hours. Not every game was associated with seizures; but, he had two similar events in the past. Upon receiving treatment (sodium valproate) and avoiding mahjong, he has remained seizure-free. The medication was stopped after five years.

2. In 1996, a 20-year-old man developed a seizure while playing mahjong, despite having no prior history and a frequent player of the game. Following the incident, he developed two more epileptic seizures, both associated with playing mahjong. He has since stopped and has been seizure-free.

3. In 2006, a 39-year-old man suffered from a GTCS after having played two hours of mahjong. He had a similar attack two year earlier, which was also triggered by mahjong. Under the advice of his doctors, the man has avoided mahjong and has been seizure-free since then.

Mahjong epilepsy is prevalent mostly amongst the Chinese population due to the popularity of the game within the region. Because of the low incidence rate, mahjong is often identified as the single cause of the epileptic event. Now, empirical evidence has further proven that avoidance of playing mahjong can effectively prevent patients with the condition from relapsing in the future. MIMS

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