To analyze clinical features of mah-jong reflex epilepsy, and to explore the underlying mechanisms.
 Methods: The clinical data of 15 patient (a study group), who visited in the outpatient department in the Third Xiangya Hospital, Central South University from 2016 to 2018, were collected and analyzed. The clinical data included disease history, 24 h- electroencephalography (EEG) and magnetic resonance imaging (MRI) scan. Next, previous 84 case (a literature group) reports published in the past 20 years were searched and compared.
 Results: Both groups of mah-jong reflex epilepsy were predominant in middle-aged men, with onset ages of (44.53±10.58) and (41.48±17.85) years old, respectively. In the study group, time interval usually lasted (4.00±2.45) h from starting play mah-jong to seizure attack, 73.3% patients complained mental fatigue before seizure attack, and 93.3% of the patients were described to have general tonic-clonic seizure. Few positive result was discovered in auxiliary examination, and the percentage was 9.3% in EEG, while no positive outcome was seen in head MRI. There were no significant differences in gender, age of onset, duration of playing mah-jong before attack, type of attack, and changes of head MRI between the 2 groups (all P>0.05).
 Conclusion: Mental fatigue after long-time mah-jong playing and cognitive dysfunction might be the potential triggers in mah-jong reflex epilepsy.
Adult ; Electroencephalography ; Epilepsy, Reflex ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Seizures