About eight years ago, I had my first epileptic seizure. I was fortunate enough to have surgery one year after that and have not had one since. For that one year, I had quite a few generalized seizures and even more auras, which are difficult to explain and can appear in many ways. In the context of epilepsy, an aura is a partial seizure where only one part of the brain is affected and the person having one is usually still conscious and aware that it is happening. They are technically considered the beginning stage of a seizure and can often be a warning sign that a larger one is about to happen, but they can also be self-contained and not lead to anything more.
Auras can also be experienced before or during a migraine episode and can lead to similar symptoms such as visual disturbances, numbness or weakness, and mumbling or slurred speech. People do not need to have epilepsy to have auras.
For me, an aura was a few minutes of inability to read, write, speak or understand what others were saying. It would also be difficult to concentrate on anything, and everything would seem to be much brighter than it really was, which would quickly cause a headache or migraine. This would happen randomly throughout the day, even though I was on several different medications to treat epilepsy at the time. I would try to continue what I was doing, which was usually looking at a computer monitor, iPhone screen or book. All these activities were affected when an aura occurred.
What can be done?
No amount of thoughtful design or WCAG guideline adherence can help someone having an aura that causes words to become jumbled on a page or spoken dialogue to turn into gibberish. However, there are some design choices that could help people who have auras that affect them in different ways. That being said, if someone is experiencing an aura that is a precursor to a generalized seizure, they would likely not be concerned about the content on the screen in front of them. The following advice can be helpful for those who experience auras that pass quickly and do not lead to a larger seizure, and can also benefit people with other disabilities, such as cognitive and vision impairments, as well as those who experience auras related to a migraine.
Summarizing content
In many cases, an aura causes a person to lose focus on what they were previously doing. Creating content that helps users reorient to their previous activity, such as providing a shortened summary of the page’s content, or a table of contents navigation, can be very helpful for a user who has trouble remembering what they last read or where they left off. This would also apply to those with short-term memory loss and other neurological disorders, such as ADHD.
Honoring system colors
Honoring system colors in design can also help those with epilepsy and migraines. I have always set my devices to “dark” mode, which helped a great deal when using native applications on my iPhone. However, websites did not always honor that option and I was faced with many bright-white pages which made headaches worse and were more difficult to look at when an aura was happening. Fortunately, it is becoming easier than ever to honor a user’s preference with the recent CSS light-dark() property. It requires less code than previous methods of offering a dark mode on websites and apps by providing a native white-on-black version out of the box. Ian Lloyd has created bookmarklets that can be used to quickly apply a dark mode to any website, and provided CSS that can be used with a browser extension like Stylus to apply the dark mode globally. This means that every website you visit will have a uniform dark mode applied to it.
Allowing for zoom
Another experience that some people have during an aura is blurred vision. This makes it difficult to see smaller text, so the user might need to magnify the content with browser zoom or increased text size. Using responsive design and allowing the content to reflow into a single column instead of requiring the user to scroll both horizontally and vertically or—even worse—letting content be cut off or overlapped by sticky elements would let the user continue to view the content during an aura if they choose to. The relevant success criterion here is 1.4.10 Reflow, which requires that content in a viewport at 320 pixels wide (or an equivalent such as 1280 CSS pixels wide at 400% zoom) or 256 pixels tall can be presented without loss of information or functionality, and without requiring scrolling in two dimensions.
Considering Level AAA
The Web Content Accessibility Guidelines (WCAG) have success criteria that are specific to seizures and the issues that could potentially trigger them – 2.3.1 Three Flashes or Below Threshold, 2.3.2 Three Flashes and 2.3.3 Animation from Interactions.
Many others can be helpful for those with epilepsy or migraines that causes auras and other periods of confusion, where navigating a relatively simple web page can be difficult and cumbersome for a period of time. These include (but are not limited to) 2.4.6 Headings and Labels, 2.5.5 Target Size (Enhanced), 2.5.8 Target Size (Minimum), 3.1.3 Unusual Words, 3.1.4 Abbreviations, and 3.1.5 Reading Level. The catch is that many of these criteria are Level AAA, which means they are the most difficult ones to meet and therefore are rarely recommended in organizational standards or followed by those who create web content.
There are many benefits that go with striving to meet at least some AAA criteria. According to the World Health Organization (WHO), around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally. The number of people affected by migraines and other headache disorders is even higher – approximately 40% of the population, or 3.1 billion people in 2021 (according to WHO). Clearly, many people can greatly benefit from the higher standards set by Level AAA criteria. Personally speaking, I know that my life would have been improved for that year if more websites were created with these guidelines in mind, and many people experience similar symptoms for much longer than that.
Summary
Designing the web for a specific disability like epilepsy or migraines would be challenging considering all the different experiences those with auras could have, and it’s doubtful that most neurologists have the time to help with that endeavor. Fortunately, it isn’t necessary to only design for one specific disability; the general goal of inclusive design is to provide content that broadly works for as many people as possible. Implementing the design strategies described in this post and paying more attention to Success Criteria at the AAA level can help so many people, including (but not limited to) those with epilepsy and migraines.
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