Many people play games like Sudoku to relax, but for one patient this visual-spatial task triggered reflex epilepsy in a case study published in JAMA Neurology.

A 25-year-old right-handed male was buried by an avalanche during a ski tour, in which he experienced 15 minutes of hypoxia and developed posthypoxic intention myoclonus with involuntary myoclonic jerks of the mouth induced by talking and of both legs by walking. Several weeks later, he developed clonic seizures of the left arm associated with a right centroparietal seizure pattern on electroencephalography when attempting to solve Sudoku puzzles that he imagined in a 3-dimensional manner. The seizures stopped immediately when the puzzle was discontinued; magnetic resonance imaging (MRI) showed no pathological findings.

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The study authors believe that hypoxia most likely caused some diffuse, widespread damage and a regional loss of right centroparietal Ufibers that led to impaired inhibition; functional activation of this hyperexcitable region can lead to focal epileptic seizures. Since stopping solving Sudoku puzzles, the patient has not had a seizure for more than five years.

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