Epilepsy is a common neurological condition affecting around 1% of the world’s population. It is characterized by the recurrent occurrence of seizures, which are disturbances of the electrical activity in the brain. The type and frequency of seizures vary widely and affect different people in different ways. The causes of epilepsy are in many instances unknown and also highly variable, ranging from brain injury to substance abuse and even genetic factors.
Most patients with epilepsy achieve a remission in seizures with the currently available antiepileptic drug therapy. However, for around one third of the patients, remission is not effectively achieved, which means that seizures are recurrent, thereby affecting their quality of life and being at greater risk of depression, anxiety, and even death. These patients require multiple drug trials and, in some cases, even surgery or neurostimulation procedures.
The majority of focal seizures originate in the temporal lobe, a vital area for memory, language, auditory, and sensory processing. In a group of epilepsy conditions known as reflex epilepsies, seizures can be triggered by several different stimuli, the most common of which is light (photosensitivity). But other unusual (and surprising!) triggers have also been described in medical literature, such as reading, hot water, tooth brushing or eating.
Music also plays an important part in epilepsy. A great review by Melissa Maguire titled “Music and its association with epileptic disorders” was published in the volume “Music, Neurology, and Neuroscience: Evolution, the Musical Brain, Medical Conditions, and Therapies” of Progress in Brain Research, earlier this year.
As discussed in that review, the connection between music and epilepsy is very complex and interesting. This is because music actually has a dichotomous effect on epileptic seizures – in some patients, music brings benefit, while in others, music can trigger seizures and lead to musicophobia. And there are also those cases where musical hallucinations arise as part of an epileptic seizure.
Music as a trigger of epileptic seizures
This form of reflex epilepsy where patients experience seizures after listening to music is known as musicogenic epilepsy; it is rare, but it has been reported since the 19th century.
But again, musical triggers work in various ways. A 2008 literature review by Pittau et al went through all the case reports of epilepsy induced or facilitated by music; the authors found 110 cases published between 1884 and 2007. And some of them are fascinatingly weird.
Some patients report seizures only when listening to specific musical genres or to specific musical instruments. But there are cases where the trigger is a specific composer or even a song.
For example, there are patients reporting seizures after listening to The Beatles, Chopin, “The Marseillaise” (France’s national anthem), the X-Files’ theme song, both Whitney Houston and Boyz II Men, Shania Twain’s ballads…
But the stimulus doesn’t necessarily have to be auditory; there are also reported cases where seizures were triggered merely by singing or thinking of music.
Clinical studies using fMRI have provided evidence of an emotional component to musicogenic seizures, suggesting that, at least in some cases, seizures are triggered by the emotional response to music as and not by the auditory stimulus. Seizures stimulated by thinking of music also support this theory since there is recruitment of musical memory and its associated emotions.
But that may not be the case when neutral music induces seizures, such as a specific sound or instrument. Here, the auditory stimulus is most likely responsible.
Music is everywhere. So, naturally, having musicogenic seizures can easily lead to a constant fear of having a seizure and, consequently, to musicophobia. This in turn can lead to social isolation and, ultimately, to depression.
Music as a symptom of epileptic seizures
Music can also be part of the clinical features of a seizure. And it can occur in multiple forms.
Musical hallucinations are one of them – in rare cases, hallucinations can occur as part of temporal lobe epilepsy. These can be simple sounds, a more complex melody, or even a specific song. There is another weird and fascinating case report where a 50-year-old man described that, before the onset of his seizure, he had a vivid musical hallucination of his favorite song: Pink Floyd’s “Another Brick in the Wall”.
Musical craving or musicophilia is another rare and fascinating phenomenon. There are reports of musicophilia development following treatment of temporal seizures. These are thought to also be highly associated with an intense emotional experience during musical exposure; the seizures may have led to a change in the emotional response processing in the brain.
There are also reports of compulsive singing, humming, or whistling occasionally arising in association with seizures. These may represent forms of automatism occurring as a release phenomenon or a learned motor pattern.
The emotional components of speech, including melody, pitch, intonation, and gestures, are collectively known as prosidy. These components may also be affected during a seizure, inducing what is known as aprosidy. Likewise, a loss of musical ability (amusia) can also occur.
In part 2 of this diptych on music and epilepsy, we’ll see how music can also be used as therapy for epilepsy.
Meanwhile, if you’d like to know more about music and the brain, I’d say the best start would be Oliver Sacks’s “Musicophilia: Tales of Music and the Brain.’
References
Keezer MR, Bell GS, & Sander JW (2015). Epilepsy-related clinical characteristics and mortality: a systematic review and meta-analysis. Neurology, 84 (17) PMID: 25917487
Maguire M (2015). Music and its association with epileptic disorders. Progress in brain research, 217, 107-27 PMID: 25725912
Ogunyemi AO, & Breen H (1993). Seizures induced by music. Behavioural neurology, 6 (4), 215-9 PMID: 24487138
Ozsarac M, Aksay E, Kiyan S, Unek O, & Gulec FF (2012). De novo cerebral arteriovenous malformation: Pink Floyd’s song “Brick in the Wall” as a warning sign. The Journal of emergency medicine, 43 (1) PMID: 19682829
Rohrer JD, Smith SJ, & Warren JD (2006). Craving for music after treatment for partial epilepsy. Epilepsia, 47 (5), 939-40 PMID: 16686661
Sacks O (2008). Musicophilia: Tales of Music and the Brain. Vintage Books, New York.
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