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Evers S. The description of epileptic seizures in the classical opera. Seizure 2024; 118:117-122. [PMID: 38688042 DOI: 10.1016/j.seizure.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024] Open
Abstract
Epilepsy or epileptic seizures have only rarely been described in the classical opera. Four operas were detected, in which epileptic seizures are described also by musical means. Three of them ("Der Golem" by Eugen d'Albert; "Idiot" by Mieczyslaw Weinberg; "Otello" by Giuseppe Verdi) describe a generalized tonic-clonic epileptic seizure by a descending chromatic scale. One opera ("The turn of the screw" by Benjamin Britten) describes temporal lobe seizures by overtone music played by the instrument celesta.
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Affiliation(s)
- Stefan Evers
- Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany; Faculty of Medicine, University of Münster, Germany.
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2
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Lees AJ, Lawson S. Earworms-A Narrative Review of Infectious Music. JAMA 2024; 331:1075-1076. [PMID: 38563845 DOI: 10.1001/jama.2024.2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This Arts and Medicine feature reviews the clinical and neurophysiologic features of earworms, music fragments heard in the mind that repeat over and over as if jammed in playback mode.
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Affiliation(s)
- A J Lees
- National Hospital, Queen Square, London, United Kingdom
| | - Sarah Lawson
- Head of Queen Square Library, UCL Queen Square Institute of Neurology, London, United Kingdom
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3
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Rodriguez W, Chennu N, Orozco L, Kaur G, Kafaie J. When the Music Comes From the Brain: A Rare Case of Auditory Seizures Secondary to a Right Temporal Lobe Arteriovenous Malformation. Cureus 2024; 16:e57932. [PMID: 38738099 PMCID: PMC11081881 DOI: 10.7759/cureus.57932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Focal seizures with subjective auditory phenomena, known as auditory seizures, are uncommon and can include simple to complex auditory hallucinations. We present a case of a 59-year-old man who presented with motor and non-motor seizures. He had a four-month history of hearing things resembling continuous metallic sounds, pennies dropping into a bank, persistent music after radio cessation, and the sound of a passing train. Brain MRI showed multiple serpiginous flow voids in the right temporal lobes, consistent with an arteriovenous malformation that was confirmed eventually with a diagnostic brain angiogram. The etiology of the seizures was related to a structural lesion in the setting of a right temporal arteriovenous malformation (AVM). Treatment with 2000mg of levetiracetam twice daily and 300mg of oxcarbazepine twice daily improved symptoms, and subsequent stereotactic radiosurgery ablation successfully treated the AVM. Post-treatment MRI showed reduced visibility of parasitized vessels, with controlled generalized seizures but partial control of auditory seizures.
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Affiliation(s)
- Wilson Rodriguez
- Neurology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Navreet Chennu
- Neurology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Lissette Orozco
- Internal Medicine, Trinity Health Ann Arbor Hospital, Ypsilanti, USA
| | - Gunjanpreet Kaur
- Neurology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Jafar Kafaie
- Neurology, Saint Louis University Hospital, Saint Louis, USA
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4
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Cossette-Roberge H, Li J, Citherlet D, Nguyen DK. Localizing and lateralizing value of auditory phenomena in seizures. Epilepsy Behav 2023; 145:109327. [PMID: 37422934 DOI: 10.1016/j.yebeh.2023.109327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Auditory seizures (AS) are a rare type of focal seizures. AS are classically thought to involve a seizure onset zone (SOZ) in the temporal lobe, but there remain uncertainties about their localizing and lateralizing value. We conducted a narrative literature review with the aim of providing an up-to-date description of the lateralizing and localizing value of AS. METHODS The databases PubMed, Scopus, and Google Scholar were searched for literature on AS in December 2022. All cortical stimulation studies, case reports, and case series were analyzed to assess for auditory phenomena that were suggestive of AS and to evaluate if the lateralization and/or localization of the SOZ could be determined. We classified AS according to their semiology (e.g., simple hallucination versus complex hallucination) and the level of evidence with which the SOZ could be predicted. RESULTS A total of 174 cases comprising 200 AS were analyzed from 70 articles. Across all studies, the SOZ of AS were more often in the left (62%) than in the right (38%) hemisphere. AS heard bilaterally followed this trend. Unilaterally heard AS were more often due to a SOZ in the contralateral hemisphere (74%), although they could also be ipsilateral (26%). The SOZ for AS was not limited to the auditory cortex, nor to the temporal lobe. The areas more frequently involved in the temporal lobe were the superior temporal gyrus (STG) and mesiotemporal structures. Extratemporal locations included parietal, frontal, insular, and rarely occipital structures. CONCLUSION Our review highlighted the complexity of AS and their importance in the identification of the SOZ. Due to the limited data and heterogeneous presentation of AS in the literature, the patterns associated with different AS semiologies warrant further research.
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Affiliation(s)
- Hélène Cossette-Roberge
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada.
| | - Jimmy Li
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Daphné Citherlet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Dang Khoa Nguyen
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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5
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Canas-Simião H, Nascimento ST, Reis J, Freitas C. Complex auditory musical hallucinations with ambivalent feelings. BMJ Case Rep 2021; 14:e245397. [PMID: 34764093 PMCID: PMC8587600 DOI: 10.1136/bcr-2021-245397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/03/2022] Open
Abstract
A 78-year-old woman with hypertension, diabetes mellitus type 2 and bilateral sensorineural hearing loss was referenced to geriatric psychiatry consultation. She presented cognitive dysfunction, erotomanic delusion and complex musical hallucinations (MH), described as hearing her neighbour singing a familiar church song along with bells in the background, making comments and talking to her. A computed tomography (CT) of the brain detected small right nucleocapsular and bilateral external capsules hypodensities of presumed vascular aetiology during hospitalisation. MH are a rare phenomenon with heterogeneous aetiology. Most frequently, the cause is hearing impairment; other causes include social isolation, cognitive dysfunction, vascular risk factors and medication. Studies suggest that some brain areas related to musical memory circuitry might be related and not fully mapped. Auditory verbal hallucinations with a voice that either comments, talks or sings to the patient have never been described in the literature, making this clinical case attractive.
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Affiliation(s)
- Hugo Canas-Simião
- Department of Psychiatry, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | | | - João Reis
- Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
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García-Falgueras A, Swaab DF. The Spanish Composer Manuel de Falla and His Eyes: The Musical Brain. Neurosci Insights 2021; 16:26331055211049778. [PMID: 34723184 PMCID: PMC8552372 DOI: 10.1177/26331055211049778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Manuel de Falla was a Spanish musician of the XIXth and XXth centuries who had international recognition likely due to his musical fusion talent. His knowledge about Spanish musical traditions gave to his early compositions a new and fresh intellectual interpretation for the typical Spanish folk music. However, in the middle of his musical career, he suffered a strange disease of his eyes named recurrent acute iridocyclitis. This eye flushing is caused by an inflammation of 2 structures of the anterior pole of the ocular globe, the iris, and the ciliary body. It is usually a symptom of another disease and it causes many psychological impairments and disabilities (severe eye pain in bright light, blurry vision, headache, stress for organization (orderliness), and depression in some cases). This soreness of his eyes had an effect over Falla’s compositions and marked an inflection point in his line of musical creations. Eyes in music have been so relevant in another composers and musicians throughout history.
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Affiliation(s)
- Alicia García-Falgueras
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.,Researcher of the Biblioteca Nacional de España (BNE), Madrid, Spain
| | - Dick F Swaab
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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7
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Marek A. [Auditory phenomena as differential diagnostics to tinnitus]. Laryngorhinootologie 2021; 100:712-719. [PMID: 34461649 DOI: 10.1055/a-1516-4720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In the auditory system, subjective tinnitus is known as phantom perception. Humans also report illusionary misperceptions of real listening impressions and complex scene-like acoustic fantasies without external hearing stimulus. The exact pathophysiological relationships of the auditory phenomena are still unclear. Important comorbidities include hearing loss, brain disease and mental disorders. METHODS In a literature search in the PubMed database, publications were evaluated until March 2021 on the search terms tinnitus, palinacousis, pareidolia, synesthesia, aura, acoustic hallucination with regard to similarities and differences to subjective tinnitus. RESULTS Subjective tinnitus can occur together with other auditory phenomena in an individual. Diagnostically important is the relationship between hearing loss and tinnitus as well as between tinnitus and hearing loss in the corresponding frequency range. With hearing loss, other auditory phenomena may occur. CONCLUSION The occurrence of various auditory phenomena simultaneously in a person suggests an auditory perceptual continuum with common physiological processing structures. People with hearing loss should be asked about the various auditory phenomena. For all auditory phenomena, audiometric examination should be part of the diagnostic standard.
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Affiliation(s)
- Astrid Marek
- HNO-Universitätsklinik Bochum, Ruhr-Universität Bochum, Medizinische Fakultät, Bochum, Germany
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8
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Al-Attas AA, Al Anazi RF, Swailem SK. Musicogenic reflex seizure with positive antiglutamic decarboxylase antibody: A case report. Epilepsia Open 2021; 6:607-610. [PMID: 34218519 PMCID: PMC8408607 DOI: 10.1002/epi4.12518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 06/25/2021] [Accepted: 07/01/2021] [Indexed: 11/07/2022] Open
Abstract
The association of musicogenic epilepsy (ME) with antibodies against glutamic decarboxylase (GAD) supports autoimmune workups for these patients. No appropriate treatment has been established for ME; therefore, immunotherapy should be considered for patients who become drug-resistant. The connection between neurological manifestations and antibodies against GAD, a rate-limiting enzyme that helps create the inhibitory neurotransmitter gamma-aminobutyric acid, has been well established. Furthermore, a strong correlation has been found between ME and the temporal lobe. However, its connection with anti-GAD antibodies is still unclear. This paper reports on a 50-year-old right-handed female who has had ME symptoms for 14 years and been found to be anti-GAD antibody-positive. Therefore, we will elaborate on the relation between ME and anti-GAD antibodies.
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Affiliation(s)
- Alawi A Al-Attas
- Department of Adult Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Riyam F Al Anazi
- Department of Adult Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.,Department of Pediatric Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Saleh K Swailem
- Department of Adult Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.,Department of Adult Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Shi LJ, Wei BX, Xu L, Lin YC, Wang YP, Zhang JC. Magnetoencephalography for epileptic focus localization based on Tucker decomposition with ripple window. CNS Neurosci Ther 2021; 27:820-830. [PMID: 33942534 PMCID: PMC8193700 DOI: 10.1111/cns.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/24/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS To improve the Magnetoencephalography (MEG) spatial localization precision of focal epileptic. METHODS 306-channel simulated or real clinical MEG is estimated as a lower-dimensional tensor by Tucker decomposition based on Higher-order orthogonal iteration (HOOI) before the inverse problem using linearly constraint minimum variance (LCMV). For simulated MEG data, the proposed method is compared with dynamic imaging of coherent sources (DICS), multiple signal classification (MUSIC), and LCMV. For clinical real MEG of 31 epileptic patients, the ripples (80-250 Hz) were detected to compare the source location precision with spikes using the proposed method or the dipole-fitting method. RESULTS The experimental results showed that the positional accuracy of the proposed method was higher than that of LCMV, DICS, and MUSIC for simulation data. For clinical real MEG data, the positional accuracy of the proposed method was higher than that of dipole-fitting regardless of whether the time window was ripple window or spike window. Also, the positional accuracy of the ripple window was higher than that of the spike window regardless of whether the source location method was the proposed method or the dipole-fitting method. For both shallow and deep sources, the proposed method provided effective performance. CONCLUSION Tucker estimation of MEG for source imaging by ripple window is a promising approach toward the presurgical evaluation of epileptics.
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Affiliation(s)
- Li-Juan Shi
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Bo-Xuan Wei
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Hefei Innovation Research Institute, Beihang University, Hefei, Anhui, China
| | - Lu Xu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Yi-Cong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Brain Functional Disease and Neuromodulation of Beijing Key Laboratory, Beijing, China
| | - Yu-Ping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Brain Functional Disease and Neuromodulation of Beijing Key Laboratory, Beijing, China
| | - Ji-Cong Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Hefei Innovation Research Institute, Beihang University, Hefei, Anhui, China
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10
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Schmitgen A, Saal J, Sankaran N, Desai M, Joseph I, Starr P, Chang EF, Shirvalkar P. Musical Hallucinations in Chronic Pain: The Anterior Cingulate Cortex Regulates Internally Generated Percepts. Front Neurol 2021; 12:669172. [PMID: 34017308 PMCID: PMC8129573 DOI: 10.3389/fneur.2021.669172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022] Open
Abstract
The anterior cingulate cortex (ACC) has been extensively implicated in the functional brain network underlying chronic pain. Electrical stimulation of the ACC has been proposed as a therapy for refractory chronic pain, although, mechanisms of therapeutic action are still unclear. As stimulation of the ACC has been reported to produce many different behavioral and perceptual responses, this region likely plays a varied role in sensory and emotional integration as well as modulating internally generated perceptual states. In this case series, we report the emergence of subjective musical hallucinations (MH) after electrical stimulation of the ACC in two patients with refractory chronic pain. In an N-of-1 analysis from one patient, we identified neural activity (local field potentials) that distinguish MH from both the non-MH condition and during a task involving music listening. Music hallucinations were associated with reduced alpha band activity and increased gamma band activity in the ACC. Listening to similar music was associated with different changes in ACC alpha and gamma power, extending prior results that internally generated perceptual phenomena are supported by circuits in the ACC. We discuss these findings in the context of phantom perceptual phenomena and posit a framework whereby chronic pain may be interpreted as a persistent internally generated percept.
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Affiliation(s)
- Ashlyn Schmitgen
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States
- UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
| | - Jeremy Saal
- UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
| | - Narayan Sankaran
- UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Maansi Desai
- Department of Speech, Language, and Hearing Science, University of Texas at Austin, Austin, TX, United States
| | - Isabella Joseph
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States
- UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
| | - Philip Starr
- UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Physiology, University of California, San Francisco, San Francisco, CA, United States
| | - Edward F. Chang
- UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Physiology, University of California, San Francisco, San Francisco, CA, United States
| | - Prasad Shirvalkar
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States
- UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
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11
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Subjective hearing ability, physical and mental comorbidities in individuals with bothersome tinnitus in a Swedish population sample. PROGRESS IN BRAIN RESEARCH 2021; 260:51-78. [PMID: 33637232 DOI: 10.1016/bs.pbr.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study investigates associations of subjective hearing ability, physical comorbidities, and mental comorbidities with bothersome (vs. non-bothersome) tinnitus and mediating effects between these influences. METHODS The Swedish LifeGene cohort was used to sample cross-sectional survey data (collected 2009-2016) of 7615 participants with tinnitus, 697 (9.2%) of whom rated their tinnitus as bothersome. Associations between bothersome tinnitus and subjective hearing ability, physical and mental comorbidities were investigated by separate age- and gender-adjusted multiple logistic regression models. Interrelationships between these associations were investigated by logistic mediation models. RESULTS Compared to non-bothersome tinnitus, bothersome tinnitus was associated with higher age, reduced subjective hearing ability, hearing-related difficulties in social situations, cardiovascular disease, chronic shoulder pain, thyroid disease, Ménière's disease, depression, anxiety syndrome, and social anxiety. Subjective hearing impairment or hearing-related difficulties mediated 13-36% of the effects of mental comorbidities on bothersome tinnitus. Depression or anxiety syndrome mediated 5-8% of most relationships between physical comorbidities and bothersome tinnitus. Depression, anxiety syndrome, or social anxiety mediated 2-4% of the effects of subjective hearing impairment or hearing-related difficulties on bothersome tinnitus. CONCLUSION Psychological factors, subjective hearing impairment, and hearing-related difficulties in social situations play key roles in predicting bothersome (vs. non-bothersome) tinnitus in a large population sample. Psychological factors contribute to explaining the impact of physical comorbidities and hearing-related effects on bothersome tinnitus. This highlights their transdiagnostic importance for aggravating varied physical symptom clusters. Interventions to improve or prevent high tinnitus burden should be interdisciplinary/multimodal and target auditory, physical, and psychological factors.
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Latini F, Trevisi G, Fahlström M, Jemstedt M, Alberius Munkhammar Å, Zetterling M, Hesselager G, Ryttlefors M. New Insights Into the Anatomy, Connectivity and Clinical Implications of the Middle Longitudinal Fasciculus. Front Neuroanat 2021; 14:610324. [PMID: 33584207 PMCID: PMC7878690 DOI: 10.3389/fnana.2020.610324] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/30/2020] [Indexed: 12/01/2022] Open
Abstract
The middle longitudinal fascicle (MdLF) is a long, associative white matter tract connecting the superior temporal gyrus (STG) with the parietal and occipital lobe. Previous studies show different cortical terminations, and a possible segmentation pattern of the tract. In this study, we performed a post-mortem white matter dissection of 12 human hemispheres and an in vivo deterministic fiber tracking of 24 subjects acquired from the Human Connectome Project to establish whether a constant organization of fibers exists among the MdLF subcomponents and to acquire anatomical information on each subcomponent. Moreover, two clinical cases of brain tumors impinged on MdLF territories are reported to further discuss the anatomical results in light of previously published data on the functional involvement of this bundle. The main finding is that the MdLF is consistently organized into two layers: an antero-ventral segment (aMdLF) connecting the anterior STG (including temporal pole and planum polare) and the extrastriate lateral occipital cortex, and a posterior-dorsal segment (pMdLF) connecting the posterior STG, anterior transverse temporal gyrus and planum temporale with the superior parietal lobule and lateral occipital cortex. The anatomical connectivity pattern and quantitative differences between the MdLF subcomponents along with the clinical cases reported in this paper support the role of MdLF in high-order functions related to acoustic information. We suggest that pMdLF may contribute to the learning process associated with verbal-auditory stimuli, especially on left side, while aMdLF may play a role in processing/retrieving auditory information already consolidated within the temporal lobe.
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Affiliation(s)
- Francesco Latini
- Neurosurgical Unit, Department of Surgery, Ospedale Santo Spirito, Pescara, Italy
| | - Gianluca Trevisi
- Neurosurgical Unit, Department of Surgery, Ospedale Santo Spirito, Pescara, Italy
| | - Markus Fahlström
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Malin Jemstedt
- Section of Speech-Language Pathology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Maria Zetterling
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Göran Hesselager
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Mats Ryttlefors
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden
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13
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Uchitel J, McDade C, Mathew M, Mantri S, Jenson D, Husain AM. Conversational analysis of consciousness during seizures. Epilepsy Behav 2020; 112:107486. [PMID: 33181894 DOI: 10.1016/j.yebeh.2020.107486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/18/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objectives of the study were to 1) investigate how patients with epilepsy describe the subjective, conscious experience of having a seizure and 2) determine whether certain themes and descriptions correspond to specific types of epilepsy. METHODS We interviewed thirteen patients with electroencephalographically confirmed epilepsy about their subjective experience of having a seizure and used conversational analysis (CA) to analyze the language they used to describe this experience. RESULTS Seven patients had focal to bilateral tonic-clonic seizures (FBTCS), 7 had focal impaired awareness seizures (FIAS), 1 had focal aware seizures (FAS), and one had generalized onset tonic-clonic (GTC) seizures. Three had multiple types of seizures. Focal seizure origin was frontal in 2 patients, right hemisphere in 1, parieto-occipital in 1, and temporal in 8. Focal to bilateral tonic-clonic and GTC seizures were most frequently associated with descriptions of a total loss of consciousness (n = 8), whereas FIAS were most frequently associated with a perceived loss of consciousness but able to describe some aspects of being unconscious (n = 5). Temporal seizures most frequently accompanied reports of memory loss/impairment (n = 4). Ten patients provided specific descriptions of the transition between the interictal and ictal state or auras. Descriptions consciousness and unconsciousness ranged significantly, resembling a continuum rather than corresponding to distinct levels. CONCLUSION The subjective experience of consciousness for patients with epilepsy may differ by seizure type and origin. These may reflect different involvement of brain regions involved in producing consciousness and arousal. Conversational analysis and narrative approaches can significantly aid clinicians in the diagnosis and management of epilepsy.
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Affiliation(s)
- Julie Uchitel
- Department of Neurology, Duke University Medical Center, Durham, NC, United States of America.
| | - Charles McDade
- Department of Neurology, Duke University Medical Center, Durham, NC, United States of America.
| | - Marika Mathew
- Department of Neurology, Duke University Medical Center, Durham, NC, United States of America.
| | - Sneha Mantri
- Department of Neurology, Duke University Medical Center, Durham, NC, United States of America; Trent Center for Bioethics, Humanities, and History of Medicine, Duke University School of Medicine, Durham, NC, United States of America.
| | - Deborah Jenson
- Duke University, Duke Institute for Brain Sciences, Durham, NC, United States of America.
| | - Aatif M Husain
- Department of Neurology, Duke University Medical Center, Durham, NC, United States of America; Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, NC, United States of America.
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14
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Abstract
PURPOSE OF REVIEW The association between hallucinations and sensory loss, especially vision- and hearing-impairment, has been firmly established over the past years. The deafferentation theory, a decrease of the threshold for activation in the brain and the consequential imbalance between excitatory and inhibitory brain networks, is hypothesized to underly this relationship. Here we review the studies investigating this theory with a focus on the most recent literature to better understand the contribution of sensory loss to hallucinations. RECENT FINDINGS A large cross-sectional study has recently confirmed the relationship between auditory impairment and deafferentation. However, the underlying mechanisms of deafferentation are still under debate, with hyperexcitability and deviations in bottom-up and top-down processes being the most likely explanations. Social isolation following sensory impairment increases the risk for hallucinations. Better knowledge and awareness about the contribution of deafferentation and loneliness would benefit diagnosis and treatment of hallucinations. SUMMARY Studies imply activity in higher order areas, corresponding to the functional mapping of sensory system, and a general state of higher excitability as neurobiological explanation. Auditory deafferentation, tinnitus and other auditory hallucinations, likely lie on a continuum. Social isolation mediates psychotic symptoms in sensory-impaired individuals. Currently, there is no standard treatment for deafferentation hallucinations.
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Transient Musical Hallucinations in a Young Adult Male Associated with Alcohol Withdrawal. Case Rep Psychiatry 2019; 2019:6546451. [PMID: 31781460 PMCID: PMC6875172 DOI: 10.1155/2019/6546451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/11/2019] [Indexed: 11/17/2022] Open
Abstract
We present the case of a 25-year-old male who presented to A&E with isolated musical hallucinations, in the absence of audiological or neurological disease. The patient had a history of recreational drug use and a family history of psychosis. Hallucinations, which were preceded by discontinuation of alcohol and reinitiation of citalopram for depression, resolved spontaneously after three days. Aetiological factors are discussed alongside the existing literature. Whilst the underlying mechanisms underpinning musical hallucinations remain elusive, the case illustrates the potential role of alcohol withdrawal, serotonin toxicity, recreational drug use, and genetic vulnerability.
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