The patient was a 25-year-old man who suffered some after-effects after being deprived of oxygen in a skiing accident. His brain triggered seizures when he performed tasks that required visual-spatial reasoning, such as sudoku.
Doctors in Germany have documented an unusual medical case in which a popular logic game, sudoku, triggered epileptic seizures in a young man who had survived an avalanche. The case highlights a rare form of reflex epilepsy, in which seizures are triggered by specific mental or sensory activities.
The patient, a 25-year-old man, suffered an accident during a ski trip in November 2008, when a avalanche left him unconscious and buried him under the snow for approximately 15 minutes. During this period, your body was deprived of oxygen, a condition known as hypoxia. A friend rescued him and immediately performed cardiopulmonary resuscitation before the man was taken to the hospital, says .
Although the patient survived, oxygen deprivation caused lasting neurological sequelae. Developed a movement disorder that causes involuntary muscle contractions in the legs when walking and in the mouth when talking. His arms were initially unaffected.
During rehabilitation, the man resumed one of his usual hobbies: Solve sudoku puzzles. Doctors noticed that whenever he worked on the puzzle, his left arm began to twitch uncontrollably. The movements stopped immediately when the puzzle was released.
Suspecting seizures, the medical team performed a series of brain imaging tests. An electroencephalogram revealed seizure activity originating in the right centroparietal region of the brain, responsible for sensory processing and spatial perception. A standard MRI showed no obvious structural damagebut more advanced imaging revealed a different story.
Functional magnetic resonance imaging scans performed while the patient solved Sudoku showed widespread brain activation, with activity particularly elevated non-centroparietal cortex. Additional analysis using diffusion tensor imaging revealed a loss of white matter inhibitory fibers in this region. These fibers normally help regulate brain activity, and their absence has led to excessive stimulation of the nerve pathways controlling the patient’s left arm.
Doctors concluded that hypoxia caused by the avalanche was the most likely cause of the damage. The overactive region of the brain produced focal epileptic seizures, specifically a type known as reflex epilepsy. In this case, the crises were triggered by visuospatial reasoning taskssuch as the mental visualization of the three-dimensional relationships necessary to solve sudoku puzzles. Similar seizures could be provoked by other spatial tasks, but not by reading, writing or simple calculations.
The patient was treated with antiepileptic medication, which successfully stopped the seizures. He also underwent physical therapy to reduce his movement difficulties. According to the medical report, he remained seizure-free for more than five years after treatment, as long as you avoid sudoku.
Reflex epilepsy is uncommon, affecting only a small proportion of patients with epilepsy. Although this was the first reported case involving Sudoku, doctors note that other games and visual-motor activities, such as chess, cards, mahjong and zipai, have been linked to similar seizure disorders.
