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.

Conclusions

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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Last Updated: 12/26/00