We identified 38 relevant papers (30 case reports, seven case series, and one prospective study). The reports were split into two groups—before and after the introduction of the Wii (www.nintendo.co.uk). Before the Wii, Nintendo’s consoles had a traditional wired controller with buttons or a joystick. Wii games, however, are controlled by a motion sensitive remote, which requires players to swing their arms, resulting in more traumatic injuries.

Early reports

One of the first cases was that of a 13 year old girl who experienced a generalised seizure after playing Super Mario Bros on her Nintendo entertainment system (1984) for almost three hours.19 This “Nintendo epilepsy” was attributed to a rapid change of on-screen patterns. A large multicentre study later showed that patients with a history of seizures when watching television were more sensitive to a game similar to Super Mario Bros than to a normal television programme.20

In the early 1990s two cases of Nintendo related incontinence were published.21 22 One described a boy who developed episodes of faecal soiling,21 and the other reported three (related) boys who suddenly developed daytime enuresis.22 All children were so engrossed in Super Mario Bros that they ignored their urge to go to the toilet. All cases were successfully treated by explaining how to pause the game. One of the authors jokingly suggested that Nintendo should develop a wet sensor that aborts the game if a player loses bladder control.22

In 1991, an author described how his son developed intense neck pain after playing his Game Boy—a portable system first marketed in 1989 with a small unlit display—for 30 minutes.23 His position while playing was reported as “hunched over, chin almost resting on his chest, elbows bent while he holds the small screen close to his face.” The boy’s problems, dubbed “Nintendo neck,” were attributed to playing in this position.

Similarly, “Nintendo elbow” was diagnosed in a 12 year old boy who had pain in his right elbow after playing his Nintendo “a lot” for more than a month.24 Symptoms resolved with non-steroidal anti-inflammatory drugs and rest.

We also found a report of “Nintendo hallucinations.” The patient, who had previously been diagnosed as having paranoid schizophrenia, had persistent auditory hallucinations of video game music.25