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It's very common in the USA for video games to come with a health warning that playing them can cause seizures. For example, the 2010 release of Sega's Sonic Colors for Nintendo Wii contains the following warning in its instruction manual:

Some people (about 1 in 4000) may have seizures or blackouts triggered by light flashes or patterns, and this may occur when they are watching TV or playing video games, even if they have never had a seizure before.

Is there medical evidence that video games can trigger seizures in people with no prior history of seizures? It's not clear if this warning is present due to actual medical evidence or whether it is more a reflection of best practices or regulatory compliance issues (e.g. the presence of a statute requiring the warning despite no medical evidence to support it).

I have no problem believing that video games can be a identified risk factor for people who already have a diagnosed neurological disorder such as epilepsy.

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    What's the actual part you're doubting here? That flashing lights can cause seizures? (This is a pretty well-known fact.) That someone who's never had a seizure before can have a seizure? (This is trivially true because everyone who has a seizure has to have had a seizure for the first time at some point.) That someone's first seizure can be due to flashing lights? (Probably a reasonable thing to wonder, although it doesn't really seem to involve a controversial claim.) That some video games have flashing lights sometimes? (That doesn't seem particularly controversial to claim.)
    – NotThatGuy
    Aug 22, 2021 at 1:58
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    @FrankHopkins Some TV shows have warnings just before the show itself airs. And why is it required for games?: probably because someone sued.
    – ProgrammingLlama
    Aug 23, 2021 at 6:00
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    @Llama indeed. I can get anxiety attacks (which can be misidentified as seizures by others) from Moire effect caused by cars driving past a window with vertical blinds. No warning signs needed as I am not going to sue the company that made the blinds.
    – jwenting
    Aug 23, 2021 at 7:46
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    @FrankHopkins There is apparently an infamous episode of Pokemon that was pulled from TV for this reason. I suspect that games are on the block more often because the particular flashing patterns are more amenable to algorithmic generation and also there is player input, so they have less control over what a player could see. A video can be made to have fewer potential triggers while a game cannot be observed from every camera angle for every combination of generated effects. Maybe this lack of control makes game makers more likely to lean on the warning, just in case.
    – ttbek
    Aug 23, 2021 at 8:20
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    video games DO cause seizures vs video games CAN cause seizures?
    – BCLC
    Aug 24, 2021 at 15:02

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Yes, video games can cause seizures, even in people without a prior history. For example, as described in the 1994 paper Video game induced seizures:

Fifteen patients who experienced epileptic seizures while playing video games are described together with a review of 20 cases in the English literature. Nine of the 15 cases and all but two of the reported cases experienced their first seizure while playing video games.

Reflex Seizures and Reflex Epilepsies cites the 1 in 4000 number, though this is for photosensitive epilepsy, while what it terms “video game-induced epilepsy” has many more triggers:

  • photosensitivity
  • pattern sensitivity
  • emotional and cognitive excitation (excitement or frustration)
  • proprioceptive stimulation (movement/praxis).

Fatigue, sleep deprivation and prolonged playing are facilitating factors.

For photosensitive epilepsy, there are now tools available that analyze video for seizure risks. PEAT is one example (free tool for non-commercial use), and HardingTest.com is another (paid service which performs the test required for TV broadcast in countries like the UK and Japan). This is great for analyzing cutscenes, and while it can be used on gameplay videos, there’s no guarantee that the player won’t do things (such as spin around in circles in a first person game) that could trigger a seizure (and sometimes this is done on purpose to trigger what is known as a self-induced seizure).

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    I think it should be noted this can happen with any video source and not just video games.
    – Joe W
    Aug 21, 2021 at 19:26
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    @JoeW True, and that is why some video clips on the BBC news websites in the UK have a warning "includes flashing images" (for example from flash photography that was captured in the video).
    – alephzero
    Aug 21, 2021 at 23:16
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    @JoeW: The reason that video games get special attention is because of the last sentence: The player might decide to do something that causes the image to rapidly flash or otherwise present a trigger. With a prerecorded video, that is not a concern as the broadcaster or producer can take reasonable precautions in advance. Or they don't, and then they get yelled at and the episode gets banned.
    – Kevin
    Aug 22, 2021 at 5:04
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    @Kevin Sure but that doesn't change the fact that video games are not the only types of video that can trigger this.
    – Joe W
    Aug 22, 2021 at 5:09
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    @JoeW: Of course not! I just linked an example of a different kind of video causing it. But it does explain why video games tend to have explicit "this might give you a seizure" warnings which you basically never see on TV or in films.
    – Kevin
    Aug 22, 2021 at 5:16
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Yes. Unlike television or movies, video games are an interactive medium, giving each player a different experience. This unpredictability makes it difficult for developers to catch potentially seizure-inducing issues. There are multiple reports of games triggering seizures in players.

  • September 4, 2021: Sonic Colors: Ultimate glitches on Switch could cause seizures. (Kotaku, Nintendo World Report, Eurogamer)
  • June 17, 2021: Pokemon Go developer Niantic is addressing issues with update that could potentially cause seizures for epileptic players. (Gamesradar)
  • March 26, 2021: Balan Wonderworld patched due to seizure risk. (Polygon)
  • December 9, 2020: Cyberpunk adds epilepsy warning after reviewer warns of seizures (BBC)
  • January 19, 2018: VRChat Players Come to Gamers Aid After He Has a Seizure (GameRant)

Games also have a tendency to use flashing effects during gameplay. To alleviate this, many recent games include photosensitive modes that reduce flashing lights. Examples include Just Shapes and Beats, Celeste, and Beat Saber. (While I have never personally experienced a seizure, I can personally attest to Beat Saber's photosensitive mode reducing eye strain.)

Even with these modes, developers cannot 100% guarantee some unintended issue can't induce a seizure, which is why so many games now come with an epilepsy warning.

See also:

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  • yup, and not just seizures but anxiety attacks in people with certain varieties of general anxiety disorder. Which is one of the reasons I had to stop playing World of Warcraft. After an update to their graphics engine the sunlight flickering through the trees in one zone was sending me into anxiety attacks...
    – jwenting
    Aug 24, 2021 at 10:30
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    do not that the games do NOT cause a person to develop the sensitivities that when triggered by the games cause anxiety attacks. Those sensitivities have to be already present and are merely triggered by the game, sometimes to a degree the person has not experienced before
    – jwenting
    Aug 24, 2021 at 10:32
  • @jwenting: This is a rather empty distinction. If the only trigger encountered is video games, how is it different?
    – Oddthinking ♦
    Aug 26, 2021 at 0:43
  • @Oddthinking It’s fair to distinguish. If you aren’t prone to epilepsy from flashing lights, games wont necessarily make you more sensitive to seizures.
    – Stevoisiak
    Aug 26, 2021 at 0:49
  • @Oddthinking it's not empty. The distinction is between the game causing a change in a person't brain that leads to developing a disease and that disease manifesting as a result of exposure to that game. It's the same as with allergies. You can't sue a peanut farmer for causing your peanut allergy, as the peanut farmer doesn't cause that allergy. His product may trigger the symptoms, but it's your own responsibility to avoid exposure to that product. The allergy is there whether you're exposed or not after all. If the game created the medical condition from scratch, it'd be outlawed.
    – jwenting
    Aug 26, 2021 at 6:26

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