"The choking game": self-induced hypoxia presenting as recurrent seizurelike events

Risk-taking behavior resulting in accidental injury is common in adolescence. Self-induced hypoxia as a means of self-stimulation, sometimes referred to as "the choking game," has recently become more widely recognized, particularly with a series of well-publicized deaths in teenagers and with wider visibility on national news and Internet sites. We report a case of self-induced hypoxia via carotid compression and breath holding that presented as recurrent confusional episodes and seizurelike events. Video/EEG monitoring was a useful tool in elucidating the neurological effects of the "game," which may result in prolonged neurological injury or life-threatening outcome.