Music and the neurologist. A historical perspective

Musicogenic seizures in temporal lobe epilepsy: Case reports based on ictal source localization analysis

Musicogenic epilepsy is a rare form of reflex epilepsy in which seizures are provoked by music. Different musicogenic stimuli have been identified: pleasant/unpleasant music or specific musical patterns. Several etiologies have been uncovered, such as focal cortical dysplasia, autoimmune encephalitis, tumors, or unspecific gliosis. In this article, we report two patients with musicogenic seizures. The first patient was diagnosed with structural temporal lobe epilepsy. Her seizures were elicited by music that she liked. Interictal and ictal video-electroencephalography (video-EEG) and signal analysis using independent component analysis revealed the right temporal lobe seizure onset extending over the neocortical regions. The patient underwent right temporal lobectomy (including the amygdala, the head, and the body of the hippocampus) and faced an Engel IA outcome 3 years post-surgery. The second patient was diagnosed with autoimmune temporal lobe epilepsy (GAD-65 antibodies). Her seizures were triggered by contemporary hit radio songs without any personal emotional significance. Interictal and ictal video-electroencephalography (video-EEG) and independent component analysis highlighted the left temporal lobe seizure onset extending over the neocortical regions. Intravenous immunoglobulin therapy was initiated, and the patient became seizure-free at 1 year. In conclusion, musicogenic seizures may be elicited by various auditory stimuli, the presence or absence of an emotional component offering an additional clue for the underlying network pathophysiology. Furthermore, in such cases, the use of independent component analysis of the scalp EEG signals proves useful in revealing the location of the seizure generator, and our findings point toward the temporal lobe, both mesial and neocortical regions.

Musicogenic epilepsy

Musicogenic epilepsy, which is a form of reflex epilepsy, is characterized by the triggering of epileptic seizures by specific music experiences. Individuals with musicogenic epilepsy differ in the music trigger, but may have similar seizures. Typically, these seizures are focal dyscognitive and have a temporal-lobe origin with a limbic system distribution. As such, the music trigger is likely related to either an emotional or memory aspect of music perception. Investigations into musicogenic epilepsy may lead to a better understanding of seizure propagation within the brain and of neurologic aspects of the music experience. Successful treatment of medication-resistant musicogenic epilepsy has been achieved with anterior temporal-lobe resection.

Impaired musical ability in people with schizophrenia

BACKGROUND

Assessment of the musical ability of people with schizophrenia has attracted little interest despite the diverse and substantive findings of impairments in sound perception and processing and the therapeutic effect of music in people with the illness. The present study investigated the musical ability of people with schizophrenia and the association with psychiatric symptoms and cognition.

METHODS

We recruited patients with chronic schizophrenia and healthy controls for participation in our study. To measure musical ability and cognitive function, we used the Montreal Battery of Evaluation of Amusia (MBEA) and the Brief Assessment of Cognition in Schizophrenia (BACS). We carried out a mediation analysis to investigate a possible pathway to a deficit in musical ability.

RESULTS

We enrolled 50 patients and 58 controls in the study. The MBEA global score in patients with schizophrenia was significantly lower than that in controls (p < 0.001), and was strongly associated with both the composite cognitive function score (r = 0.645, p < 0.001) and the negative symptom score (r = -0.504, p < 0.001). Further analyses revealed direct and indirect effects of negative symptoms on musical ability. The indirect effects were mediated through cognitive impairment.

LIMITATIONS

The relatively small sample size did not permit full evaluation of the possible effects of age, sex, education, medication and cultural influences on the results.

CONCLUSION

Examining the associations between musical deficits, negative symptoms and cognitive imapirment in patients with schizophrenia may identify shared biological mechanisms.

Efficacy of music therapy in treatment for the patients with Alzheimer's disease

We report that music therapy is effective in the treatment of Alzheimer's disease. We found that the secretion of 17β-estradiol and testosterone, hormones that are supposed to have preventive effects on Alzheimer's disease, is significantly increased by music therapy. During the sessions, patients with Alzheimer's disease were allowed to listen to music and songs with verbal contact from the therapist. It was found that problematic behaviors such as poriomania (fugue) had decreased. Music therapy has the potential as an alternative treatment for adverse hormone replacement therapy.

Music therapy research in the NICU: an updated meta-analysis

PURPOSE

To provide an overview of developmental and medical benefits of music therapy for preterm infants.

DESIGN

Meta-analysis.

SAMPLE

Empirical music studies with preterm infants in the neonatal intensive care unit (NICU).

MAIN OUTCOME

Evidence-based NICU music therapy (NICU -MT ) was highly beneficial with an overall large significant effect size (Cohen's d = 0.82). Effects because of music were consistently in a positive direction.

RESULTS

Results of the current analysis replicated findings of a prior meta-analysis and included extended use of music.(1) Benefits were greatest for live music therapy (MT ) and for use early in the infant's NICU stay (birth weight <1,000 g, birth postmenstrual age <28 weeks). Results justify strong consideration for the inclusion of the following evidence-based NICU -MT protocols in best practice standards for NICU treatment of preterm infants: music listening for pacification, music reinforcement of sucking, and music pacification as the basis for multilayered, multimodal stimulation.

Amusia and musicogenic epilepsy

Amusia and musicogenic epilepsy are clinical disorders that provide a window into the localization of music in the brain. Classic clinical studies of patients with these disorders, coupled with more recent studies employing modern neuroimaging and sophisticated neuropsychologic paradigms, have converged in helping to elucidate the complex neural systems that are utilized in decoding music. The notion of cerebral dominance for music has been replaced by a concept of modular but interconnected networks that have wide bilateral localization in the brain and that are molded both by genetics and experience. These disorders also provide insight into the important interface between music and emotion.

Expressive aprosody and amusia as a manifestation of right hemisphere seizures

PURPOSE

Aprosody and amusia are disorders commonly associated with right hemisphere abnormalities. They are regarded as negative phenomena and usually seen after strokes. We report a case of a patient who had both expressive aprosody and amusia as a clinical manifestation of right temporooccipital seizures.

METHODS

A 43-year-old woman had a 1-month history of monotonic speech and difficulty singing. Her examination revealed both expressive aprosody and amusia. Magnetic resonance imaging of the head was normal, but her EEG revealed several electrographic seizures of right temporooccipital origin.

RESULTS

Treatment with phenytoin (PHT) almost immediately caused her speech and singing to return to baseline. A repeated EEG was normal

CONCLUSIONS

Seizures of right temporooccipital origin can manifest with expressive aprosody and amusia.