Abstracts

Rationale: A recent review of musicogenic epilepsy by Tinuper et al. included 110 patients reported since 1984. Most had unilateral epileptic discharges, with an overwhelming preponderance in the non-dominant hemisphere; only 3 had bitemporal discharges. We present three female patients with musicogenic epilepsy who had bilateral temporal interictal discharges and seizure onsets. In these three patients, surgical treatment was not considered possible as they had no atrophy and no convincing lateralization. This conundrum is the reason for the presentation. Methods: Review of medical records and investigations of three patients. Results: Patient 1, a 52-year-old woman, has had temporal lobe seizures since the age of 8 years. Some of her attacks, those with a déjà vu aura, were precipitated by music and by a certain voice with emotional significance. She had normal hippocampal volumes. Stereotactic EEG recorded temporal seizures with onset mostly from the right side but also independently from the left. Medication was not sufficiently effective. Patient 2, a 51-year-old woman, had her first temporal seizure 3 months after hysterectomy. Attacks recurred cyclically once a month. Almost all were provoked by listening to certain types of music or to the news. Videotelemetry recorded two seizures originating from the left temporal region while listening to TV, and two from the right while listening to music. Brain MRI, hippocampal volumes and curvilinear reconstruction were normal. Medical treatment was unsatisfactory. Patient 3, a 38-year-old woman, has had temporal lobe seizures since the age of 19. Some of her attacks, those starting with an unsafe feeling, a déjà vu aura and a rising epigastric sensation, were characteristically triggered by music, especially Johnny Cash’s song “Ring of Fire”. The patient also had complex partial seizures with lip smacking, fumbling automatisms and inability to respond, as well as convulsive seizures. The first videotelemetry recorded left-sided onset of four seizures, and one simple partial seizure from the right. One year later, intracranial monitoring showed bilateral onset of seizures. MRI scan showed subtle loss in internal architecture and increased T2 signal in the left hippocampus. An ictal SPECT scan, performed with injection immediately after onset of the seizure, showed abnormal tracer increase in the right temporal lobe. The seizures were intractable to medication. Conclusions: Unlike the great majority of patients with musicogenic epilepsy described in the recent review, these three women had seizures arising independently from both temporal lobes. Their musicogenic seizures were not exclusively triggered by identifiable musical or other auditory stimuli. Reliable distinction between reflex versus “spontaneous” seizures was not possible. Despite the intractability of the seizures, surgical treatment was not considered appropriate in these three patients with no atrophy of mesial temporal structures or obvious neocortical changes.