Mahjong indoctrination starts early in China.

Anyone that knows me outside of the blogosphere, knows I won’t turn down a good game of Mahjong. Part of the  fun is figuring out which scoring system your host is going to use, because I swear to to this day it changes by the minute. “Oh, is that a special hand worth 10,000 yuan??” Yeah right! I’ve never won a game but it is lots of fun and good excuse to drink rice wine with friends. But according to study by Chang et al. in 2007 it may be more hazardous to my health if I took it more seriously. This study reports case studies on ‘mahjong epilepsy’, a rare reflex epilepsy syndrome that occurs as recurrent epileptic seizures triggered by playing or even watching mahjong be played by others. In particular, they detail 3 different case studies.

Case Study 1: 79 year old male, played mahjong for eight hours, held a ready hand when onset of a generalised tonic-clonic seizure (GTCS) occurred. Upon admittance, normal neurological exam, EEG and CT. Man had a history of two other events while playing mahjong within the last three years. Stopped playing mahjong after third seizure and has not had any since (eight years later).

Case Study 2: 42 year old male, seizure while playing mahjong. Normal neurological exam, EEG and CT as well. He abstained from mahjong then resumed playing mahjong after a few years. Three years after resuming mahjong he had two seizures while playing (even with resumption of medicine). Quit playing for good, seizure free for last 18 months.

Case Study 3: 39 year old male, seizure onset after two hours of playing mahjong. Unremarkable examinations and scans. Avoids mahjong now, no seizures.

The authors note that:

“Reflex seizures associated with mah-jong, brought on by either playing or watching the game, constitute a rare condition not recognised until recently. To date, only 20 cases of ‘mah-jong epilepsy’ (MJE) have been reported in the English literature.”

The mean age of onset was 54 years, range 34-76 yrs. (n=23), males outnumber females 10:1 and attack frequency ranged from one every 3 years to more than 30 a year (depending on x, y, z).

“Mah-jong is a cognitively demanding game. It involves substantial higher mental processing and outputs: memory, concentration, calculations, reasoning, strategies, sequential thinking and planning, consideration of alternative solutions, and a lot of decision-making. From this perspective, mahjong–induced seizures are best classified as a subtype or manifestation of cognition-induced epilepsy”

Wait a second, thinking, calculating and making decisions can make you prone to seizures! Someone better tell my advisor this.

Click on table to display larger version.

Understandably, its pretty rare and I am sure sleep deprivation after playing 10+ hours and stress over losing copious amounts of money contribute greatly. I can see how someone’s cognitive system just shuts down or freaks out! Take it easy when you play mahjong! Play with fake money instead and drink plenty of water!

Chang RS, Cheung RT, Ho SL, & Mak W (2007). Mahjong-induced seizures: case reports and review of twenty-three patients. Hong Kong medical journal, 13 (4), 314-8 PMID: 17664536