This summer more than 23,000 people crowded into New York City’s Arthur Ashe Stadium to watch their favorite Fortnite players compete to win $30 million in prize money. The players may have been wearing Nike apparel, but this was no ordinary sporting event. In fact, the only running that occurred was from offstage to individual computer terminals. There, players sat to competitively play Fortnite, a multiplayer video game that currently boasts more than 250 million players worldwide.
Headshot of Jose Posas
Jose Posas, MD

One of those players—though he was a little too busy with his day job to attend the championship in New York—is Jose Posas, MD, a neurologist at Ochsner Health System in New Orleans. As a long-time gamer, Posas likes to keep up with the latest gaming innovations. As a neurologist, he has a keen interest in how all this gaming affects the brain.

Health professionals have long suspected that internet gaming in particular, has an effect on the brain’s reward center. In 2013, Internet Gaming Disorder was introduced into the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition worthy of further study, where it remains today.

Meanwhile, the companies that make these games have been cashing in on people’s drive to play. Posas says that, ironically, when Fortnite stopped charging to download their game, they started making even more money. “They made more money because more people started downloading haircuts, and costumes, and different kinds of guns and golf carts. They were making all these micro transactions within the game. You are engaging the brain circuits that are part of the dopamine reward system, and it’s like gambling basically.”

Whether gaming addiction is a bonafide disorder (related to gambling or not) remains under debate, according to the American Psychiatric Association. But there are other brain effects that have also been associated with playing video games.

“There are studies that show video games actually change the gray matter thickness on MRI,” says Posas, who points to a study out of the Max Planck Institute in Germany using the game Super Mario 64. Increased plasticity was observed in the right hippocampus, right prefrontal cortex and the cerebellum in players compared to controls. According to the authors this relates to functions like “spatial navigation, memory formation, strategic planning and fine motor skills of the hands.”

Posas says video games have been shown to improve a variety of other skills including hand-eye coordination, visual-spatial memory, visual motor speed, past recognition, executive function, pattern recognition, and visual acuity.

Improvements in vision have been linked to first-person shooter games like Fortnite and Call of Duty, he says. “There is something about that rapid fire, target acquisition, on a complex visual background, using hand-eye coordination, and using your eyes and binocular vision to do it, even with a falsified depth of field, that is beneficial to visual acuity.”

Clinicians are beginning to harness the brain-changing power of video games. Posas describes one group out of Johns Hopkins that is using a dolphin video game to help patients rehabilitate from stroke. “[The patient is] able to continue their exercises at home for the purposes of increasing neuroplasticity and getting the brain to regenerate and heal itself. It is a very exciting frontier.”

Posas believes we are only just beginning to see the benefits video games can bring to medicine. Unfortunately as of yet, very few games are validated for therapeutic use. The barrier of entry is so high and there is much less money to be made with this application. For now, all the potential benefits are wrapped up in the very lucrative gaming industry. “The financial yield is so high because it’s entertainment,” says Posas. “How do you get people to care enough to resolve this issue of money versus human health?”

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