Nonketotic hyperglycemia-related reflex epileptic seizures induced by Mah-Jong playing

Seizures related to nonketotic hyperglycemia (NKH) are often encountered in clinical practice. Among such seizures, reflex seizures are rare, and most of them are movement-induced focal seizures. We describe five patients with NKH and reflex seizures induced exclusively by playing Mah-Jong, a traditional and popular game in Chinese society. Four patients had partial seizures and one had a generalized seizure. All the patients manifested NKH on occurrence of the seizure. During Mah-Jong in the presence of NKH, seizures could arise from the frontal and temporal lobes, which are highly activated during the game. Both avoidance of Mah-Jong playing and control of glucose intake help prevent this disorder.