Abstracts

Rationale: Musicogenic epilepsy (ME) is a rare form of epilepsy provoked by listening to or playing music, and has been localized to the temporal lobe. The number of reported cases of ME investigated with intracranial electroencephalography (iEEG) is extremely small, especially with coverage of the superior temporal plane (STP) and specifically Heschl’s gyrus (HG). The goals of this study were to describe a recent case of ME investigated with iEEG with STP and HG coverage, review the literature on iEEG findings in ME, explain our approach to HG depth electrode placement, and discuss the utility of STP depth electrodes in temporal lobe epilepsy. Methods: A 17-year-old viola player with a history of medically intractable ME began having simple partial seizures (some with dyscognitive features) at 11 years of age. The semiology involved a sensation of hearing indescribably distorted and rhythmic sounds that became more distorted with longer and more extensive seizures. The seizures were often triggered by variable sounds, songs, or rhythms, although he was not able to identify any particular auditory stimuli that consistently evoked seizures. They did not have an emotional component, nor were they triggered by any emotional content. He underwent chronic iEEG monitoring that involved coverage of the STP with a HG depth electrode anteriorly and a planum temporale (PT) depth electrode posteriorly. The literature review was performed using the PubMed database with search terms “musicogenic epilepsy” and “intracranial EEG” to identify cases of iEEG investigation in ME. Results: Five seizures occurred during the monitoring period, and the seizure onset zone was localized to HG and STP. The patient subsequently underwent right temporal neocortical resection, involving the STP and including HG, with preservation of the mesial temporal structures. The pathology was consistent with focal cortical dysplasia type I. He remains seizure-free 10 months postoperatively, with stable strong cognitive functions without auditory deficits. Ten cases of ME investigated with iEEG were identified in the literature, where seizure focus was unilaterally or bilaterally localized either to the mesial temporal structures or to the advanced auditory areas in the PT or lateral temporal cortex. In only three cases were depth electrodes placed in the STP to cover HG, although the descriptions of the detailed electrode positions were limited. Conclusions: This is the first reported case of ME in which a seizure focus was localized to HG and STP based on iEEG findings. This case illustrates that a tailored resective surgery after appropriate seizure focus localization with iEEG in ME can result in excellent seizure and neuropsychological outcome. STP depth electrodes are useful in localization of temporal lobe seizures involving the STP as well as guiding the medial and posterior extent of resection intraoperatively. Differences across patients in complexity and specificity of auditory triggers for seizures may reflect involvement of the different components within the auditory network. Funding: None