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

'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.

Hong Kong Med J 2007;13:314-8

Key words: Cerebral cortex; Electroencephalography; Epilepsy, generalized; Epilepsy, reflex; Gambling