Do virtual reality interventions cause seizures in the critically ill? A rapid review

The objective of this research was to investigate if the use of virtual reality, increasingly utilised within intensive care medicine due to its demonstrated benefits in improving pain and anxiety, has been reported to result in seizures.

A rapid systematic review and synthesis of qualitative and quantitative data was performed.

Five databases (PubMed, Scopus, EMBASE, PsycInfo, and CINAHL) were systematically searched. An additional gray literature search was also conducted. Articles were restricted to those published on or after January 1st, 2014.

The number of participants, virtual reality sessions, and length of sessions was undertaken. Subgroup analysis was undertaken for both adult and paediatric patient populations. An additional subgroup analysis was undertaken on articles which did not exclude individuals with a history of epilepsy. A tailored risk-of-bias assessment was conducted.

Of the 563 articles identified through database and gray literature searching, 27 articles met inclusion criteria. A total of 886 patients have been reported within the literature with a combined 1843 virtual reality sessions, totalling more than 614.64 h of virtual reality. No seizures have been reported within intensive care patients receiving virtual reality interventions.

Historically, individuals with a history of epilepsy and photosensitivity have been commonly excluded from interventions and clinical trials involving virtual reality. The results of this systematic review demonstrate that the risk of virtual reality is minimal when utilised appropriately. A history of photosensitivity or epilepsy should not constitute an absolute contraindication for the use of virtual reality. Instead, clinicians should utilise clinical judgement when evaluating a patient's risk and ensure that appropriate visual experiences are utilised which do not unnecessarily strobe the patient.