A study released in the Hong Kong Medical Journal detailed the cases of 23 adult men, three in Hong Kong and 20 in Taiwan, who suffered fits brought on by playing the game of skill.
In some of the cases, drug treatment proved ineffective in stopping the seizures, which only ended after the players gave up the game.
"Mah-jong is a cognitively demanding game involving substantial higher mental processing and outputs," a statement from the journal said.
It added that the game could spark "decision-making epilepsy," which can also be triggered by playing chess and card games, as well as complex board games.
Mah-jong is a Chinese game for four players that is played using 144 domino-like tiles.