Abstracts

Rationale: To describe a case of musicogenic epilepsy with partial seizures triggered by a specific song with an important emotional component.Methods: A 36-year-old right-handed man, an amateur musician, has had frequent seizures with ascending gastric sensation, tachycardia and oro-alimentary-automatisms since the age of 24 years. All the seizures were musicogenic, appearing every time the patient played his guitar or listened to music, namely melodies with a strong emotional charge (e.g. Anastasia’s song “Overdue Goodbye”), whereas neutral songs were ineffective. The patient underwent prolonged video-polygraphic recording (including EEG, ECG, plethysmogram, blood pressure, oronasal and abdominal breathing) and brain fMRI study during which he listened to both neutral and emotionally charged music. The Montreal Battery Evaluation Amusia (MBEA) was also administered to the patient. Results: Interictal EEG showed epileptiform abnormalities over right temporal regions. Video-polygraphic recordings documented three right temporal seizures, all triggered by listening to the emotionally charged melody. The seizures were preceded for several seconds by an increase in heart rate and blood pressure. The fMRI study showed activation in right acoustic areas during neutral music while emotionally charged melody provoked a widespread activation over the right fronto-temporo-occipital area before seizure onset. Conclusions: Musicogenic epilepsy is a rare form of complex reflex epilepsy. The effective stimulus can be stereotyped for each patient but with no clear common pattern among patients. A strong affective feeling provoked by specific melodies seems to be the triggering stimulus in our patient as the seizures were preceded for several seconds by an increase in heart rate and blood pressure. Our results support the role of the right temporal lobe in this kind of epilepsy. The cerebral areas activated during the emotional status leading to the seizures encompass the auditory cortex activated by neutral music.