Musicogenic seizure

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Musicogenic seizure, also known as music-induced seizure, is a rare type of seizure, with an estimated prevalence of 1 in 10,000,000 individuals, that arises from disorganized or abnormal brain electrical activity when a person hears or is exposed to a specific type of sound or musical stimuli. [1] [2] There are challenges when diagnosing a music-induced seizure due to the broad scope of triggers, and time delay between a stimulus and seizure. [3] [4] In addition, the causes of musicogenic seizures are not well-established as solely limited cases and research have been discovered and conducted respectively. [1] Nevertheless, the current understanding of the mechanism behind musicogenic seizure is that music triggers the part of the brain that is responsible for evoking an emotion associated with that music. [1] Dysfunction in this system leads to an abnormal release of dopamine, eventually inducing seizure. [5]

Contents

Currently, there are diverse intervention strategies that patients can choose from depending on their situations. They can have surgery to remove the region of the brain that generates a seizure. [6] Behavioral therapy is also available; patients are trained to gain emotional control to reduce the frequency of seizure. [1] Medications like carbamazepine and phenytoin (medication for general seizure) also suggest effectiveness to mitigate music-induced seizures. [7]

Signs & symptoms

While the signs and symptoms of musicogenic seizures are similar to that of other focal seizures, one unique distinction is the variation in the time interval between the stimulus and seizure among different patients. [4] Unlike most focal seizures, the duration between the triggering musical stimulus and seizure varies among patients; some patients encounter the seizure imminently after the trigger, while some experience a wide time gap between the stimulus and seizure. [4]  During this latent prolonged time lapse, the symptoms experienced are autonomic responses. [8] Patients may encounter changes in respiratory rate, blood pressure, and heart rate such as tachycardia, leading them to feel distressed and agitated. [9] [8]

Furthermore, hallucinations are often experienced when encountering a seizure triggered by a musical stimulus. [8] For example, musical release hallucinations and synesthetic experiences are the most common hallucinations associated with music-induced seizures. [8] Musical auditory hallucinations may also develop due to epilepsy in the temporal lobe, which is found to be affected in 75% cases of musicogenic seizures. [4]

Causes

Musicogenic seizures are generally defined as a focal seizure, as the lateral and mesial temporal, and orbitofrontal areas of the brain are affected. [10] Musicogenic seizures have complex stimuli due to the broad scope of possibilities of triggers. [3]

A wide spectrum of triggers has been noted to stimulate musicogenic seizures and musicogenic epilepsy as the type of music and method of perceiving music varies from one patient to another. [4] It has been reported that 17% of music-evoked seizures are induced solely by music, while 53% are induced by miscellaneous musical stimuli. [4] Examples of musical triggers not only include listening to noise, sound, volume, pure words, genre, singer, song, and anthem, but also playing, thinking and dreaming of music. [3] [8] [11] Among these triggers, most patients tend to be triggered by a specific tune, song or singer. [12] Musical characteristics such as cadence, frequency, and timbre are possible reasoning behind the musical stimuli. [3] Hence, this proposes that a particular rhythmic activity or pattern induces a seizure. [12]

Mechanism

An electroencephalogram (EEG) of the mesial temporal lobe of a patient in seizure. Epilepsy- right hippocampal seizure onset.png
An electroencephalogram (EEG) of the mesial temporal lobe of a patient in seizure.

Although the understanding of the exact causes of musicogenic seizures is currently not fully known, a commonly understood mechanism is that this epilepsy is associated with emotional responses to music rather than the music itself. [1] Specifically, music creates an emotional response that is activated by the limbic areas. [1] This emotional effect of the music then triggers the increase of dopamine in the different parts of the brain, eventually leading to hyperexcitation, which is an abnormal excitation of neurons, and generation of seizures in those areas when there is a dysfunction in this system. [5]

This notion is supported by many functional imaging studies like fMRI, PET scan, and clinical studies which suggested that patients of the musicogenic seizure often express emotional feelings before the onset of the seizure. [13]


Fig.1 A diagram that shows the process involved in the auditory sensory relay from air vibrations from music to the primary auditory cortex CAES9722 fig1.jpg
Fig.1 A diagram that shows the process involved in the auditory sensory relay from air vibrations from music to the primary auditory cortex

Emotional associations of music

The general relationship of the association between emotion and music is that after the auditory sensory relay of the musical information to the primary auditory cortex (shown in figure 1), the hippocampal connection in the brain encodes the association of positive/negative emotions with certain music in the memory. [1] Given this memory, when a person receives musical information from the environment, the hippocampus relays the emotional information related to that music to the mesolimbic system, which regulates the association of emotion and dopamine release. [14]

These connections between the hippocampus, mesolimbic system, and auditory cortex provide a possible mechanism of music-induced seizure by helping the brain to relate music to emotion and dopamine release. [1] Dysfunction in this sensory relay network leads to an abnormal release of dopamine, eventually inducing hyperexcitability of neurons and seizure when certain music is heard. [5] Moreover, scientists discovered that there are other parts of the brain like basolateral amygdala involved in this connection between music, emotion, and seizure. [15] Hence, this suggests that the mechanism behind musicogenic seizure still remains obscure and more research is required to fully understand it. [1]

Diagnosis

The diagnoses of music-induced seizures are complicated as the nature of stimulus is relatively unique in the ambit of seizure triggers. [3] The usual diagnosis of seizures is routinely carried out through electroencephalography (EEG), physical examination and a review of patient history. However, an EEG may not be appropriate to diagnose and test a person with music-evoked seizures since EEG is used to test photosensitive epilepsy, a form of epilepsy where seizures are stimulated by light. [11] While an EEG typically tests varied frequencies of a light stimulus, musicogenic seizures are stimulated differently by music. [11]

Moreover, there may be a time period delay between the music or sound stimulus received and seizure triggered. [11] The time gap between the stimulus and the response heightens the challenge of diagnoses. Recent hypotheses recommended testing routine electroencephalography (REEG) or amplitude-integrated electroencephalography (AEEG) to test music-evoked seizures. However, further obstacles arise in deducing the type of sound, song, and style of music which affects the patients with musicogenic seizures. [4] There is a large range of possible sounds that may trigger musicogenic seizures, such as church bells, a song associated with nostalgia, dissonant sounds, and classical music.

Treatment

Illustration of deep brain stimulation Deep brain stimulation.jpg
Illustration of deep brain stimulation

Once the patient is diagnosed with the disease, there are diverse interventions that patients can choose from including surgical, behavioral, and medicinal treatments. [1]

Surgery

Surgical intervention is suitable for patients with refractory epilepsy. [6] Specifically, the patients undergo partial resectioning of the part of the brain that generates a seizure. [6] This region is identified by imaging techniques like EEG. [6]

For patients who are not suitable to undergo a resectioning treatment, deep brain stimulation and vagus nerve stimulation may be effective alternatives; however, results suggest that it is often difficult for both deep brain and vagus nerve stimulation to completely stop seizures. [16]

Behavioral therapy

Behavioral or psychotherapeutic interventions may be effective in treating musicogenic epilepsy. [17] These therapies work by helping patients gain emotional control and thereby reducing the frequency of seizure. In fact, many patients often assert that their seizures are stopped after this behavioral therapy. [17]

Structural formula of carbamazepine, a commonly used medication for epilepsy treatment. Carbamazepine Structure.svg
Structural formula of carbamazepine, a commonly used medication for epilepsy treatment.

Medicine

Many pharmacological interventions have shown positive results. Often carbamazepine, phenytoin, and lamotrigine, commonly used for general epilepsy treatment, are prescribed to patients with music-induced seizure. [6] In some patients, these medications show better results when combined with oxcarbazepine, sodium valproate, or levetiracetam, which are also other medications for general epilepsy treatment. [6]

Epidemiology

Globally, epilepsy and seizures are among the most severe of the common neurological disorders . [18] Active epilepsy, defined as people who have continuing seizures or require treatment, can be found in 4-10 individuals per 1000 worldwide. A higher prevalence has been reported in low-income and middle-income countries at 7 to 15 cases of active epilepsy per 1000 individuals. [19] Musicogenic epilepsy is a rare subtype of these, with an estimated prevalence of 1 in 10,000,000 individuals. [1]

The actual prevalence is perceived to be greater than reported. Due to the limited number of reported cases, insufficient research has been conducted on musicogenic seizures and musicogenic epilepsy. [1] It has been suggested that the disorder has a higher tendency to affect females, while the average age of onset is 28. [9] Nonetheless, the age of presentation is usually at 39, therefore suggesting an underestimated prevalence. [4] Moreover, the underestimated prevalence of musicogenic seizures could also be due to challenges in diagnosis such as deducing music as a seizure trigger. [4]

Related Research Articles

<span class="mw-page-title-main">Hallucination</span> Perception in the absence of external stimulation that has the qualities of real perception

A hallucination is a perception in the absence of an external stimulus that has the qualities of a real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. Hallucination is a combination of two conscious states of brain wakefulness and REM sleep. They are distinguishable from several related phenomena, such as dreaming, which does not involve wakefulness; pseudohallucination, which does not mimic real perception, and is accurately perceived as unreal; illusion, which involves distorted or misinterpreted real perception; and mental imagery, which does not mimic real perception, and is under voluntary control. Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus is given some additional significance. Many hallucinations happen also during sleep paralysis.

An evoked potential or evoked response is an electrical potential in a specific pattern recorded from a specific part of the nervous system, especially the brain, of a human or other animals following presentation of a stimulus such as a light flash or a pure tone. Different types of potentials result from stimuli of different modalities and types. Evoked potential is distinct from spontaneous potentials as detected by electroencephalography (EEG), electromyography (EMG), or other electrophysiologic recording method. Such potentials are useful for electrodiagnosis and monitoring that include detections of disease and drug-related sensory dysfunction and intraoperative monitoring of sensory pathway integrity.

Motivational salience is a cognitive process and a form of attention that motivates or propels an individual's behavior towards or away from a particular object, perceived event or outcome. Motivational salience regulates the intensity of behaviors that facilitate the attainment of a particular goal, the amount of time and energy that an individual is willing to expend to attain a particular goal, and the amount of risk that an individual is willing to accept while working to attain a particular goal.

A gamma wave or gamma rhythm is a pattern of neural oscillation in humans with a frequency between 25 and 140 Hz, the 40 Hz point being of particular interest. Gamma rhythms are correlated with large scale brain network activity and cognitive phenomena such as working memory, attention, and perceptual grouping, and can be increased in amplitude via meditation or neurostimulation. Altered gamma activity has been observed in many mood and cognitive disorders such as Alzheimer's disease, epilepsy, and schizophrenia. Elevated gamma activity has also been observed in moments preceding death.

<span class="mw-page-title-main">Aura (symptom)</span> Symptom of epilepsy and migraine

An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is a seizure.

Long-term or "continuous" video-electroencephalography (EEG) monitoring is a diagnostic technique commonly used in patients with epilepsy. It involves the long-term hospitalization of the patient, typically for days or weeks, during which brain waves are recorded via EEG and physical actions are continuously monitored by video. In epileptic patients, this technique is typically used to capture brain activity during seizures. The information gathered can be used for initial prognosis or long-term care management.

<span class="mw-page-title-main">Temporal lobe epilepsy</span> Chronic focal seizure disorder

In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. Temporal lobe epilepsy is the most common type of focal onset epilepsy among adults. Seizure symptoms and behavior distinguish seizures arising from the medial temporal lobe from seizures arising from the lateral (neocortical) temporal lobe. Memory and psychiatric comorbidities may occur. Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. Anticonvulsant medications, epilepsy surgery and dietary treatments may improve seizure control.

Reflex seizures are epileptic seizures that are consistently induced by a specific stimulus or trigger making them distinct from other epileptic seizures, which are usually unprovoked. Reflex seizures are otherwise similar to unprovoked seizures and may be focal, generalized, myoclonic, or absence seizures. Epilepsy syndromes characterized by repeated reflex seizures are known as reflex epilepsies. Photosensitive seizures are often myoclonic, absence, or focal seizures in the occipital lobe, while musicogenic seizures are associated with focal seizures in the temporal lobe.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.

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Racine stages are a categorization of epileptic seizures proposed by Ronald J. Racine in 1972. Prior to Racine's research in epilepsy, a quantifiable means to describe seizure intensities and their causes was not readily available. Racine's work allowed for epilepsy to be understood on a level previously thought impossible.

<span class="mw-page-title-main">Euphoria</span> Intense feelings of well-being

Euphoria is the experience of pleasure or excitement and intense feelings of well-being and happiness. Certain natural rewards and social activities, such as aerobic exercise, laughter, listening to or making music and dancing, can induce a state of euphoria. Euphoria is also a symptom of certain neurological or neuropsychiatric disorders, such as mania. Romantic love and components of the human sexual response cycle are also associated with the induction of euphoria. Certain drugs, many of which are addictive, can cause euphoria, which at least partially motivates their recreational use.

<span class="mw-page-title-main">Frisson</span> Psychophysiological response to rewarding auditory or visual stimuli

Frisson, also known as aesthetic chills or psychogenic shivers, is a psychophysiological response to rewarding stimuli that often induces a pleasurable or otherwise positively-valenced affective state and transient paresthesia, sometimes along with piloerection and mydriasis . The sensation commonly occurs as a mildly to moderately pleasurable emotional response to music with skin tingling; piloerection and pupil dilation not necessarily occurring in all cases.

Kindling is a commonly used model for the development of seizures and epilepsy in which the duration and behavioral involvement of induced seizures increases after seizures are induced repeatedly. Kindling is also referred as an animal visual model of epilepsy that can be produced by focal electrical stimulation in the brain. This is mainly used in visualising epilepsy in humans. The kindling model was first proposed in the late 1960s by Graham V. Goddard and colleagues. Although kindling is a widely used model, its applicability to human epilepsy is controversial.

The neuroscience of music is the scientific study of brain-based mechanisms involved in the cognitive processes underlying music. These behaviours include music listening, performing, composing, reading, writing, and ancillary activities. It also is increasingly concerned with the brain basis for musical aesthetics and musical emotion. Scientists working in this field may have training in cognitive neuroscience, neurology, neuroanatomy, psychology, music theory, computer science, and other relevant fields.

Forced Normalization (FN) is a psychiatric phenomenon in which a long term episodic epilepsy or migraine disorder is treated, and, although the electroencephalogram (EEG) appears to have stabilized, acute behavioral, mood, and psychological disturbances begin to manifest. If, or when, treatment for the disorder is halted, the disturbances go away, but the episodic spikes on the EEG reappear. H. Landolt coined the term 'Forced Normalization' in 1953 in response to a change he witnessed in epileptic EEGs, which monitor electrical activity in the brain. These changes were followed by abrupt behavioral changes in the patient. Landolt concluded that forced normalization is "the phenomenon characterized by the fact that, with the occurrence of psychotic states, the electroencephalography becomes more normal or entirely normal, as compared with previous and subsequent EEG findings." Forced normalization, as described by Landolt, was therefore an electrophysiological phenomenon with the electroencephalograph at its helm.

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Musical hallucinations describes a neurological disorder in which the patient will hallucinate songs, tunes, instruments and melodies. The source of these hallucinations are derived from underlying psychotic illness or hearing impairment. These hallucinations are often rare and are followed by mental decline. Majority of patients who have symptoms of musical hallucinations are older and have onset conditions predisposing them to the disease. While there is no set form of treatment, research has discovered medications and alternative therapies to be successful in alleviating the hallucinations.

<span class="mw-page-title-main">Occipital epilepsy</span> Medical condition

Occipital epilepsy is a neurological disorder that arises from excessive neural activity in the occipital lobe of the brain that may or may not be symptomatic. Occipital lobe epilepsy is fairly rare, and may sometimes be misdiagnosed as migraine when symptomatic. Epileptic seizures are the result of synchronized neural activity that is excessive, and may stem from a failure of inhibitory neurons to regulate properly.

Music-evoked autobiographical memories (MEAMs) refer to the recollection of personal experiences or past events that are triggered when hearing music or some musical stimulus. While there is a degree of inter-individual variation in music listening patterns and evoked responses, MEAMs are generally triggered in response to a wide variety of music, often popular or classical genres, and are estimated to occur in the range from one to a few times per day, regardless of formal instrumental practice or music lessons. Consistent with the hallmarks of general autobiographical memories, everyday MEAMs similarly exhibit a recency effect, a reminiscence bump, and childhood amnesia, encoding autobiographical knowledge at several levels of specificity and across several common social and situational contexts. The phenomenon of MEAMs has been widely studied in the fields of psychology, neuroscience, and musicology. In recent years, the subject has garnered significant interest from researchers and the general public alike due to music's capacity to evoke vivid, emotional, and episodically rich autobiographical memories.

References

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