By: Catherine Joachin
Musicogenic Epilepsy
Musicogenic Epilepsy
Musicogenic epilepsy is a form of reflex epilepsy (RE) in which seizures are consistently triggered by specific music experiences (Ellis, 2017). It is usually associated with complex focal seizures, predominantly affecting the temporal lobe (75% of cases) and the right hemisphere (61%), with possible secondarily generalized tonic-clonic seizures (Ellis, 2017).
This condition is relatively rare, as it only occurs in 1 in 10 million people (Ellis, 2017). In fact, although anecdotal reports of music-induced seizures predate the emergence of electroencephalography (EEG), barely over a hundred cases of musicogenic epilepsy have been reported in the literature (Striano et al., 2012). Moreover, the sparsity of scientific data on this form of RE is further exacerbated by the fact that relevant literature on this topic is almost exclusively limited to case reports (Ellis, 2017).
Nonetheless, evidence from functional imaging studies investigating the effects of epileptogenic music on brain activity shows increased activity in brain regions involved in processing the emotional components of music prior to seizure onset but after exposure to a stimulus, suggesting that the effective trigger is likely tied to with a strong emotional and memory-related aspect of music perception (Ellis, 2017).
Triggers vary widely across individuals, and can change over time, ranging from a string of notes, to particular singing voices, instrumental, religious, lyrical or classical music (Pelliccia et al., 2019).
The average age of onset (i.e., the age at which symptoms first appear) for musicogenic epilepsy is 28, however the average age of presentation (i.e., the age at which patients seek medical evaluation) is 37 (Ellis, 2017). This discrepancy is likely due to difficulties in recognizing music as a trigger and the insufficient knowledge of health professionals on the matter, further emphasizing the need for additional research in this area.
Treatment and Management
Current treatment options for musicogenic epilepsy include pharmacological first-line agents carbamazepine and lamotrigine, with oxcarbazepine, sodium valproate and levetiracetam either alone or in combination with other alternatives (Ellis, 2017). Of course, seizure type varies per patient and so does prescription.
For those with drug-resistant epilepsy, partial removal of the temporal lobe or seizure focus (if identified) is possible, however this does not guarantee complete remission. Additionally, deep brain stimulation and vagus nerve stimulation are also available options.
That said, the limited availability of pharmacological and surgical options in certain areas of the world warrant a need for additional, more-accessible alternatives.
Conclusion
Musicogenic epilepsy is a focal epilepsy marked by seizures triggered by particular musical sounds. Treatment options are currently limited to few drug and surgical interventions. Further research on musicogenic epilepsy is needed to address the lack of knowledge of health professionals and current gaps in literature in relation to disease pathogenesis, seizure onset and management.
References
Ellis, L. (2017). The potential mechanism of musicogenic epilepsy and future research avenues. Bioscience Horizons, 10. https://doi.org/10.1093/biohorizons/hzx004
Pelliccia, V., Villani, F., Gozzo, F., Gnatkovsky, V., Cardinale, F., & Tassi, L. (2019). Musicogenic epilepsy: A Stereo-electroencephalography study. Cortex, 120, 582–587. https://doi.org/10.1016/j.cortex.2019.02.005
Striano, S., Coppola, A., del Gaudio, L., & Striano, P. (2012). Reflex seizures and reflex epilepsies: Old models for understanding mechanisms of epileptogenesis. Epilepsy Research, 100(1–2), 1–11. https://doi.org/10.1016/j.eplepsyres.2012.01.013
