A gameplay design spec for an epilepsy condition mod — feedback welcome

Hey all,

I've been working on a design spec for an epilepsy condition mod for Sims 4 and I wanted to share it here before I commit to building. This isn't a "Sim falls down sometimes" gimmick — it's a full hidden-condition system with appointments, medication, recovery, heritability, and long-term consequences. Sharing it in summary form below. Would genuinely love feedback before I start the actual implementation.

Where this comes from

Before I get into the design, I want to be upfront about where it came from, because I think it matters.

This mod isn't the result of research. I didn't read a Wikipedia article on epilepsy and decide it would make an interesting gameplay system. I've had epilepsy for over 20 years. Every mechanic in this spec is something I've lived — the appointment cycle, the prescription dependency, the auras, the postictal nausea, the activity restrictions in the hours after a tonic-clonic, the disclosure conversations with friends and partners, the way a bad week of sleep and stress will stack until your body decides for you. The cheat-dismissal layer exists because I know what it's like to want to step out of the condition for a while, even if you can't actually do that in real life.

Dr. Feldman is named after my actual neurologist. The popup voice I'm trying to write is hers — the way she actually talks to me. That's why her name, gender, and tone aren't open to revision. She's a real person who has done real care for a real patient, and the character is a small private thank-you to her.

I'm sharing this partly so the design choices make sense (the realism isn't ornamental — it's lived), and partly because I think it's the most honest way to invite feedback. If something in here reads wrong to other people with epilepsy, I want to know. If something reads off to people without epilepsy, I want to know that too. This is one person's experience trying to become a system that holds up for other people's stories, and that needs other eyes on it.

The core idea

A Sim can be assigned epilepsy randomly at age-up (~1.2%, matching real prevalence) or via cheat. Once active, they enter a recurring care loop:

Schedule appointment → attend appointment → prescription renewed → refill medication → take meds daily → risk stays low. Break the chain and risk climbs.

Neurologist appointments

Every two in-game weeks, always with Dr. Feldman — a single named NPC who only appears through popups and notifications. No provider variety, no "find a new neurologist" interaction. She's competent, warm, plain-spoken. One consistent medical voice across every household running the mod.

This is deliberate. It mirrors how a lot of people actually manage epilepsy long-term — you find a neurologist who works for you and you stay with them. It also kills a huge amount of implementation overhead (no NPC generation, no relationship stats per provider, no provider-variant popup tables).

Medication

Daily action that maintains a med_level stat (12hr half-life decay). Four medications with real mechanical differences:

• Topamax — long half-life, strong protection, cognitive side effects
• Vimpat — balanced, low side effects, common switch target
• Clobazam — short half-life, strong acute protection, drowsy
• Lamictal — longest half-life, most forgiving, slow 5–7 day onset

These aren't arbitrary picks — they're the medications that have actually been part of my own treatment over the years, which is why I know the half-life curves and side-effect profiles well enough to model them. Dr. Feldman recommends switches based on the Sim's seizure history via popup. About 30–40% of appointments fire a decision-based popup; the rest are routine renewals.

Popups — where Dr. Feldman actually lives

Since Dr. Feldman never appears as a visible Sim, her whole character comes through popup text. Two categories:

Informational (no decision, just dismiss):

• "Reminder: appointment with Dr. Feldman tomorrow at 10:00 AM. The clinic asks that you arrive ten minutes early."
• "You missed your appointment with Dr. Feldman. Your prescription will expire soon — please call to reschedule."
• "[Sim Name] had a seizure at school today. The nurse called — [she/he/they] is on the way home to rest."
• "[Sim Name] had a seizure at work today and was sent home. Their manager has been notified; no action needed."
• "Your prescription has run out. Schedule an appointment with Dr. Feldman to get a refill."
• "[Sim Name] is feeling off today. Something doesn't seem right — keep an eye on them." (soft pre-aura warning)

Decision-based (Yes / Cancel, real mechanical consequences):

• "Dr. Feldman reviewed your seizure log and would like to increase your dose. The medication you're on isn't holding the line right now. Try the higher dose?"
• "Dr. Feldman is pleased — no breakthrough seizures in a while. She wants to try lowering your dose to reduce side effects. Step down?"
• "Dr. Feldman looked at your latest EEG and wants to switch you to a different medication. She thinks it'll suit you better. Make the change?"
• "Dr. Feldman wants you to come in for a follow-up EEG next week. It'll take about an hour. Schedule it?"
• "Dr. Feldman is concerned about how long you went without medication. She wants to start an emergency stabilization plan — daily check-ins for a week. Begin treatment?"

Yes branches generally improve protection but may add side-effect risk or simoleon cost; Cancel keeps things as they are, and Dr. Feldman may bring it up again at a future appointment. She doesn't badger and she doesn't moralize. She just keeps offering. That's how my real neurologist actually operates, and I wanted that captured.

The voice rule across all of it: competent, warm but not saccharine, plain clinical language, respectful when the patient declines. Not a comic character, not a villain. A good doctor.

Seizure events

Two types, assigned per-Sim (60% Grand-Mal tonic-clonic / 40% Complex Partial focal):

• Aura: 8–15s of rapid emotion cycling. Player's window to react. ~15–20% chance the aura resolves without progressing.
• Tonic-clonic: 10–15s, full collapse, locked queue
• Focal: 8–14s, Sim freezes/wanders/repeats motion
• Postictal: 1–2 in-game hours of Dazed + Exhausted, autonomous rest-seeking

The implementation trick I'm most proud of: the tonic-clonic event reuses the existing death-by-collapse animation, bypassing the death system itself. Need drains (Energy, Hygiene, Social) replace the actual death. Zero custom animation work. The animation is already rigged, already uninterruptible by design, already does exactly the right visual.

Game speed drops to normal automatically when an aura starts — a seizure at speed 3 would be 4 real seconds and unreadable.

Risk calculation

Multiplicative, not additive. Base 0.5% per hour, modified by medication coverage, prescription lapse, low needs, negative emotions, and acute emotional spikes. A well-managed Sim sits near 0.2%/hour and almost never has events. A neglected Sim — no meds, all needs low, sleep-deprived, multiple negative emotions stacked — can hit 30%+.

The multiplicative model comes from how my own threshold actually works. It's not that any one bad factor will set off an event; it's that they compound. Bad sleep alone is usually survivable. Bad sleep plus a missed dose plus a high-stress week is the combination that gets me. This is the part I most want feedback on. Does multiplicative stacking feel right in a Sims mod context, or is it going to produce weird edge cases where one specific combination is wildly over- or under-tuned?

Postictal recovery

After tonic-clonics specifically:

• Postictal nausea (~50% base, up to 70% if recently eaten). Sim rushes to nearest toilet, reuses the existing vomit animation. This is realistic and I don't want to gloss over it — it's a real part of recovery that almost never gets depicted in media, and leaving it out felt like sanitizing the experience.
• Next-day excused absence from work/school. Doesn't consume PTO, doesn't ding grades. Fully automatic medical accommodation.
• Activity restrictions for 6–8 in-game hours: no stove cooking, no showering (baths OK), no swimming, no ladders, no power tools. Soft limits on screens.

The activity restrictions create real interdependency in multi-Sim households — aware household members can autonomously cook for and check on the postictal Sim. I like this a lot as emergent storytelling, and it reflects how my own household actually works on a bad recovery day.

Extended systems (the parts I'm least sure about)

Heritability — One epileptic parent → ~6% child risk. Both parents → ~15%. Inherited condition stays dormant from birth; activates probabilistically at child (30%), teen (45%), or young adult (20%) age-up. Carriers who never activate can still pass it on. Creates legacy-save continuity.

Comorbidities — ~20% of epileptic Sims develop hidden Comorbid Depression, ~25% Comorbid Anxiety. They don't get their own appointment loops — they're modifier layers on emotion autonomy and risk. Dr. Feldman can refer to a counselor or prescribe anxiolytics via popup. Including this layer was important to me because the comorbid mental-health side of epilepsy is real and rarely talked about. A mod that pretends epilepsy is just seizures would be missing most of the actual experience.

Social disclosure — Other Sims learn about the condition via voluntary disclosure or witnessed seizure. Reactions are trait-based: Good/Family-Oriented/Geek react positively, Mean/Snob/Hot-Headed react negatively, most traits land neutral-to-mild-positive. The world isn't hostile by default — that's a deliberate design choice. Awareness reduces Embarrassment from future public seizures. Non-disclosure to a serious romantic partner who later witnesses a seizure carries a relationship penalty.

Long-term consequences — Hidden Workplace Resilience stat affects career advancement. Some careers soft-cap at mid-tier (military combat, pro athlete, surgeon). Caregiver Bond stat builds with supportive household members and unlocks deeper interactions, but long-term solo caregivers risk burnout. Personality biases at age-up: rough childhood with the condition pushes slightly toward introspective traits; well-managed history pushes toward Responsible-coded traits. Elder Sims who reach old age with the condition unlock a unique Resilient reward trait.

Player comfort

Everything except earned positive outcomes can be cleared with cheats. Any long-term penalty, accumulated seizure history, social fallout, comorbidity, or the whole condition itself — all dismissible. The Resilient trait stays if earned. Negative consequences are always reversible. I want this to be a system you can lean into as deeply as you want, or back out of completely, with no save-state regret.

What I'd love to hear from you all

1. Does the overall loop feel like a Sims mod, or have I over-engineered it into something that belongs in a different game?
2. The death-animation reuse for tonic-clonics — clever, or going to read as broken to anyone who recognizes it?
3. The Dr. Feldman approach (one NPC for every household) — does that work, or are players going to expect provider variety?
4. The extended systems (heritability, comorbidities, social disclosure, long-term consequences) — necessary depth, or scope.
5. Anything in the risk math that looks like it'll produce weird edge cases?
6. Anything missing that you'd expect from a mod like this?

And the bigger ask: I'm a designer, not a modder. I can write specs, balance numbers, and write Dr. Feldman's popup voice all day, but I can't write the Python or wrangle the XML to actually build this. If you're an experienced Sims 4 modder — especially anyone who's worked with custom traits, hidden conditions, interaction injection, or rabbit-hole career integration — and this project speaks to you, I'd genuinely love to talk. Whether that's a full collaboration, mentorship while I learn, or just a sanity-check on which parts are realistic to build vs. which I should drop, any level of engagement is welcome.

The full spec is about 30 pages and I'm happy to share it with anyone seriously interested. DM me or comment below.

Thanks for reading. This one matters to me.