Preservation of absolute pitch after right amygdalohippocampectomy for a pianist with TLE

Should absolute pitch be considered as a unique kind of absolute sensory judgment in humans? A systematic and theoretical review of the literature

Absolute pitch is the name given to the rare ability to identify a musical note in an automatic and effortless manner without the need for a reference tone. Those individuals with absolute pitch can, for example, name the note they hear, identify all of the tones of a given chord, and/or name the pitches of everyday sounds, such as car horns or sirens. Hence, absolute pitch can be seen as providing a rare example of absolute sensory judgment in audition. Surprisingly, however, the intriguing question of whether such an ability presents unique features in the domain of sensory perception, or whether instead similar perceptual skills also exist in other sensory domains, has not been explicitly addressed previously. In this paper, this question is addressed by systematically reviewing research on absolute pitch using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method. Thereafter, we compare absolute pitch with two rare types of sensory experience, namely synaesthesia and eidetic memory, to understand if and how these phenomena exhibit similar features to absolute pitch. Furthermore, a common absolute perceptual ability that has been often compared to absolute pitch, namely colour perception, is also discussed. Arguments are provided supporting the notion that none of the examined abilities can be considered like absolute pitch. Therefore, we conclude by suggesting that absolute pitch does indeed appear to constitute a unique kind of absolute sensory judgment in humans, and we discuss some open issues and novel directions for future research in absolute pitch.

The left dorsal stream causally mediates the tone labeling in absolute pitch

Absolute pitch (AP) refers to the ability to effortlessly identify given pitches without any reference. Correlative evidence suggests that the left posterior dorsolateral prefrontal cortex (DLPFC) is responsible for the process underlying pitch labeling in AP. Here, we measured the sight‐reading performance of right‐handed AP possessors and matched controls under cathodal and sham transcranial direct current stimulation of the left DLPFC. The participants were instructed to report notations as accurately and as fast as possible by playing with their right hand on a piano. The notations were simultaneously presented with distracting auditory stimuli that either matched or mismatched them in different semitone degrees. Unlike the controls, AP possessors revealed an interference effect in that they responded slower in mismatching conditions than in the matching one. Under cathodal stimulation, this interference effect disappeared. These findings confirm that the pitch‐labeling process underlying AP occurs automatically and is largely nonsuppressible when triggered by tone exposure. The improvement of the AP possessors’ sight‐reading performances in response to the suppression of the left DLPFC using cathodal stimulation confirms a causal relationship between this brain structure and pitch labeling.

Retained absolute pitch after selective amygdalohippocampectomy

This study assessed the pre-operative chronic condition and effect of epilepsy surgery in a 21-year-old Japanese woman with drug-resistant right temporal lobe epilepsy (TLE). For this patient, it was crucially important to preserve language and her music capabilities, including absolute pitch (AP), which is found in the general population at less than 0.1%. The patient became seizure free, and her AP capability was preserved after selective amygdalohippocampectomy in the non-dominant right hemisphere. Most of the neuropsychological test (WAIS-III and WMS-R) scores remained in the normal range, except for low scores in verbal memory and markedly improved attention/concentration index. The patient's pre- and postoperative brain function related to language and music capabilities were investigated using functional magnetic resonance imaging (fMRI) based on two language tasks and a music task (listening to melodies). While task performance was similar in pre- and postoperative examinations, her brain activation patterns markedly differed. The most striking difference was during the music task: areas with significant activation existed in the bilateral frontal and temporal lobes before surgery, whereas postoperative activation was confined to a very limited region in the left angular gyrus. The authors speculate that the surgery triggered some change in functional organization in the brain, which contributed to preserving her capabilities.

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A music student with drug-resistant temporal lobe epilepsy (TLE) became seizure free.

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Postoperative evaluation exhibited almost stable AP ability and cognitive function.

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Brain activation patterns on fMRI showed a notable change after surgery.

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Surgery possibly triggered some change in functional organization of the brain.

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Change in functional organization possibly contributed to preserving the capabilities.

A right amygdalohippocampectomy: A diagnostic challenge

OBJECTIVE

Amygdalohippocampectomy (AHE) is the resective surgery for medically intractable mesial temporal lobe epilepsy. To date no study has investigated a wide range of neuropsychiatric symptoms in right AHE outpatients.

PATIENTS AND METHODS

Three patients with right AHE participated in this study. The control group are patients with cognitive complaints with no history of epilepsy or neurological impairment and no structural abnormalities on the MRI/CT. We expected no difference in verbal memory compared to the controls. Concerning affective Theory of Mind (ToM) we expect a difference between controls and AHE patients. In terms of behavior it is expected that coping and behavioral questionnaires do not significantly differ between AHE and controls, but that proxies of AHE patients do report more behavioral/psychiatric symptoms.

RESULTS

No significant difference was found between groups concerning the cognitive functions. For affective ToM we did find a significant difference (p=0.044). A significant difference for the use of more reassuring thoughts (p=0.006) and a trend for less passive reactions on the coping questionnaire, suggesting an 'active coping style'. Overall, AHE patients report fewer problems the self- reported questionnaires. Proxies of the AHE patients reported a trend for more behavioral disinhibition compared to proxy ratings of the control group.

CONCLUSION

Right AHE patients underestimate their behavioral and emotional changes due to self-awareness deficits. Ratings of significant others are of immense importance for the detection of psychiatric and behavioral problems. Lesions in the amygdala- orbitofrontal cortex connection disrupt the emotional network, which might explain our results.

On the Perceptual Subprocess of Absolute Pitch

Absolute pitch (AP) is the rare ability of musicians to identify the pitch of tonal sound without external reference. While there have been behavioral and neuroimaging studies on the characteristics of AP, how the AP is implemented in human brains remains largely unknown. AP can be viewed as comprising of two subprocesses: perceptual (processing auditory input to extract a pitch chroma) and associative (linking an auditory representation of pitch chroma with a verbal/non-verbal label). In this review, we focus on the nature of the perceptual subprocess of AP. Two different models on how the perceptual subprocess works have been proposed: either via absolute pitch categorization (APC) or based on absolute pitch memory (APM). A major distinction between the two views is that whether the AP uses unique auditory processing (i.e., APC) that exists only in musicians with AP or it is rooted in a common phenomenon (i.e., APM), only with heightened efficiency. We review relevant behavioral and neuroimaging evidence that supports each notion. Lastly, we list open questions and potential ideas to address them.

Intracortical myelination in musicians with absolute pitch: Quantitative morphometry using 7-T MRI

Absolute pitch (AP) is known as the ability to recognize and label the pitch chroma of a given tone without external reference. Known brain structures and functions related to AP are mainly of macroscopic aspects. To shed light on the underlying neural mechanism of AP, we investigated the intracortical myeloarchitecture in musicians with and without AP using the quantitative mapping of the longitudinal relaxation rates with ultra‐high‐field magnetic resonance imaging at 7 T. We found greater intracortical myelination for AP musicians in the anterior region of the supratemporal plane, particularly the medial region of the right planum polare (PP). In the same region of the right PP, we also found a positive correlation with a behavioral index of AP performance. In addition, we found a positive correlation with a frequency discrimination threshold in the anterolateral Heschl's gyrus in the right hemisphere, demonstrating distinctive neural processes of absolute recognition and relative discrimination of pitch. Regarding possible effects of local myelination in the cortex and the known importance of the anterior superior temporal gyrus/sulcus for the identification of auditory objects, we argue that pitch chroma may be processed as an identifiable object property in AP musicians. Hum Brain Mapp 37:3486–3501, 2016. © 2016 Wiley Periodicals, Inc.

Surgical strategies for pediatric epilepsy

Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Approximately 20-30% of children with recurrent seizures have drug-resistant epilepsy (DRE). For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes. The spectrum of surgical options is vast, ranging from outpatient procedures such as vagus nerve stimulation to radical interventions including hemispherectomy. The thread connecting all of these interventions is a common goal-seizure freedom, an outcome that can be achieved safely and durably in a large proportion of patients. In this review, we discuss many of the most commonly performed surgical interventions and describe the indications, complications, and outcomes specific to each.