Abstracts

Rationale: Musicogenic Epilepsy (ME) consists of seizures precipitated by musical stimuli. The pathophysiology of musicogenic seizures is not well understood. Previous studies indicate that ME often originates from right temporal lobe, and due to the wide variability of musical triggers, it has also been posited that ME may be elicited through mechanisms having more to do with emotional processing than auditory content. The following describes a case of ME, and the evolution of its semiology in conjunction with management of the patient's mood disorder. Methods: Case report Results: A 42-year old right handed man with generalized anxiety disorder (GAD) experienced syncopal episodes starting in 2010. He felt lightheaded, then lost consciousness, which was followed by tongue biting and body shaking as reported by witnesses. The events were also triggered with stress. Over time, episodes changed such that they were triggered by background music in stores. He was prescribed carbamazepine, then levetiracetam, both of which decreased event frequency. However, the patient self-discontinued his antiepileptic medications, after which he was started on venlafaxine by a psychiatrist for GAD, with improvement of anxiety symptoms. His events subsequently evolved, and were no longer spontaneous or triggered by background music. Instead, they were precipitated by hearing music from, or similar to, what he listened to during times of stress as a younger man. After such a stimulus, he would feel his heart racing, then experience an out-of-body sensation, followed by loss of consciousness. Magnetic resonance imaging of the brain was normal. Ambulatory electroencephalography (EEG) demonstrated rare focal slowing in the left temporal region and rare sharp waves in the left anterior temporal region. Inpatient video EEG monitoring recorded one seizure of left frontotemporal onset at T1/T3, which started 2 minutes after playing the song "La Femme D'Argent" by Moon Safari, a known trigger. "Neutral" music, consisting of baroque classical music from an online streaming station, did not elicit seizures. The patient was started on topiramate and had no further events. Conclusions: ME is a rare syndrome responsive to medication and, in individuals with pure musicogenic seizures, avoidance of triggers. Emotional processing appears to play a role in pathogenesis, as illustrated by this case, in which GAD management coincided with the manifestation of pure musicogenic seizures, and warrants further investigation. Funding: None