A Neuropsychological Case Study of Musicogenic Epilepsy
Martha E. Banks, Ph.D.
Diversified Computer Processing, Inc.
Rosalie J. Ackerman,
Timken Mercy Medical Center
Diversified Computer Processing, Inc.
Research and Development Division
566 White Pond Drive
Suite C #178
Akron, OH 44320-1116
Musicogenic epilepsy is a form of reflex or affective epilepsy, and involves
autonomic, behavioral, cognitive, and emotional reactions to selected musical
stimuli. This case examines neurological reactions, emotional responses,
and psychological adaptations to psychoacoustic stimuli. Differential diagnosis
of seizure activity was based on neuropsychological data, observations
of reflexes and autonomic reactions, and lack of habituation. Dramatic
differences between ictal and interictal cognitive processing were exhibited.
Patient is a married 66 year old retired male blue collar worker with 15
years of formal education. He complained that he "lost track of time" when
he listened to music he enjoyed. His family reported that he would "shake"
when "moved" by certain pieces of music. The wife expressed "curiosity"
about the cause of the behavior which had been observed since the patient's
adolescence. This behavior had become a concern when patient had a reaction
to music while driving and narrowly avoided a serious accident. Both the
patient and his wife had previously considered the reactions benign.
Three types of seizures were observed:
absence to high revolution motor noise,
partial complex to psychoacoustic properties of music, and
déjà vu or simple complex to negative emotional
associations with familiar music.
Methods and Results
During the baseline neuropsychological testing with the Ackerman-Banks
Neuropsychological Rehabilitation Battery, the patient was observed
to have 12 episodes of brief (2-10 second) absences which impaired his
test performance. WAIS-R verbal, performance, and full scale intelligence
quotients were at the top of the Superior range. Neuropsychological deficits
included poor receptive prosody, difficulty with long-term memory, confabulation,
lack of awareness of deficits, and low frustration tolerance.
Patient was exposed to music which elicited complex partial and déjà
vu seizures during the initial 20 minutes of a 2-hour ictal
neuropsychological test session. The testing was a repetition of the baseline
measures used on the previous day. Patient had difficulty with items involving
abstraction and tasks which were timed. Intelligence quotients were slightly
lower during the ictal evaluation. Patient had relative deficits in alertness,
prosody, short-term memory, cognitive problem solving, speech, emotional
control, and social skills, as well as severe problems with lack of awareness
of deficits in his performance and very low frustration tolerance. Postictal
confusion with confabulated responses, poor judgment, impulsivity, dyspraxia,
poor balance and dyscoordination of hand motions, and severe dysnomia were
noted. His behaviors did not habituate and his performance only slowly
improved during the 1-1/2 hours following the musicogenic seizures.
The epileptogenic music was analyzed to determine which properties elicited
Babinski reflexes, myoclonus, head tilts, partial complex seizures, increased
blood pressure, respiration changes, and elevation of surface temperatures
in the fingers and frontalis. Specific rates of vibrato/periodicity observed
both with music and other environmental sounds (e.g., high revolution motors)
elicited the above autonomic behaviors.
This paper was presented at the 1994 convention of the National
Academy of Neuropsychology in Orlando, FL.
Psychoacoustic properties of music and other sounds elicit absence and
complex partial seizures; reflex seizure manifestation is related to duration
of exposure to specific vibrato conditions.
Déjà vu, or secondary (simple partial), seizures are
better classified as affective seizures; they involve associations between
familiar music and specific memories, often associated with negative traumata.
In reflex and affective seizures, patient admitted to a strong emotional
component. Musicogenic seizures are induced by both psychoacoustic and
psychological factors, as noted by Daly and Barry in 1957.
No habituation occurred in any of the seizure types; the same progression
of neurobehaviors was observed across time. This patient's seizure symptoms
are consistent with cases in the musicogenic epilepsy literature.
Stimuli in the patient's environment need to be carefully screened in order
to minimize the occurrence of seizures.
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