Impaired recognition of fear in voices and reduced anxiety after unilateral temporal lobe resection

Dynamic facial emotion recognition and affective prosody recognition are associated in patients with temporal lobe epilepsy

Deficits in facial emotion recognition have frequently been established in temporal lobe epilepsy (TLE). However, static, rather than dynamic emotion recognition paradigms have been applied. Affective prosody has been insufficiently studied in TLE, and there is a lack of studies investigating associations between auditory and visual emotion recognition. We wished to investigate potential deficits in a dynamic morph task of facial emotion recognition and in an affective prosody recognition task, as well as associations between both tasks. 25 patients with TLE and 24 healthy controls (CG) performed a morph task with faces continuously changing in their emotional intensity. They had to press a button, as soon as they were able to recognize the emotion expressed, and label it accordingly. In the auditory task, subjects listened to neutral sentences spoken in varying emotional tones, and labeled the emotions. Correlation analyses were conducted across both tasks. TLE patients showed significantly reduced prosody recognition compared to CG, and in the morph task, there was a statistical trend towards significantly reduced performance for TLE. Recognition rates in both tasks were significantly associated. TLE patients show deficits in affective prosody recognition, and they may also be impaired in a morph task with dynamically changing facial expressions. Impairments in basic social-cognitive tasks in TLE seem to be modality-independent.

Revisiting emotion recognition in different types of temporal lobe epilepsy: The influence of facial expression intensity

Temporal lobe epilepsy (TLE) can induce various difficulties in recognizing emotional facial expressions (EFE), particularly for negative valence emotions. However, these difficulties have not been systematically examined according to the localization of the epileptic focus. For this purpose, we used a forced-choice recognition task in which faces expressing fear, sadness, anger, disgust, surprise, or happiness were presented in different intensity levels from moderate to high intensity. The first objective of our study was to evaluate the impact of emotional intensity on the recognition of different categories of EFE in TLE patients compared to control participants. The second objective was to assess the effect of localizationof epileptic focus on the recognition of EFE in patients with medial temporal lobe epilepsy (MTLE) associated or not with hippocampal sclerosis (HS), or lateral temporal lobe epilepsy (LTLE). The results showed that the 272 TLE patients and the 68 control participants were not differently affected by the intensity of EFE. However, we obtained group differences within the clinical population when we took into account the localization of the temporal lobe epileptic focus. As predicted, TLE patients were impaired in recognizing fear and disgust relative to controls. Moreover, the scores of these patients varied according to the localization of the epileptic focus, but not according to the cerebral lateralization of TLE. The facial expression of fear was less well recognized by MTLE patients, with or without HS, and the expression of disgust was less well recognized by LTLE as well as MTLE without HS patients. Moreover, emotional intensity modulated differently the recognition of disgust and surprise of the three patient groups underlying the relevance of using moderate emotional intensity to distinguish the effect of epileptic focus localization. These findings should be taken into account for interpreting the emotional behaviors and deserve to befurther investigated before considering TLE surgical treatment or social cognition interventions in TLE patients.

Functional patterns of neural activation during vocal emotion recognition in youth with and without refractory epilepsy

Epilepsy has been associated with deficits in the social cognitive ability to decode others' nonverbal cues to infer their emotional intent (emotion recognition). Studies have begun to identify potential neural correlates of these deficits, but have focused primarily on one type of nonverbal cue (facial expressions) to the detriment of other crucial social signals that inform the tenor of social interactions (e.g., tone of voice). Less is known about how individuals with epilepsy process these forms of social stimuli, with a particular gap in knowledge about representation of vocal cues in the developing brain. The current study compared vocal emotion recognition skills and functional patterns of neural activation to emotional voices in youth with and without refractory focal epilepsy. We made novel use of inter-subject pattern analysis to determine brain areas in which activation to emotional voices was predictive of epilepsy status. Results indicated that youth with epilepsy were comparatively less able to infer emotional intent in vocal expressions than their typically developing peers. Activation to vocal emotional expressions in regions of the mentalizing and/or default mode network (e.g., right temporo-parietal junction, right hippocampus, right medial prefrontal cortex, among others) differentiated youth with and without epilepsy. These results are consistent with emerging evidence that pediatric epilepsy is associated with altered function in neural networks subserving social cognitive abilities. Our results contribute to ongoing efforts to understand the neural markers of social cognitive deficits in pediatric epilepsy, in order to better tailor and funnel interventions to this group of youth at risk for poor social outcomes.

Impaired Emotion Processing and Panic Disorder After Left Anterior Temporal Lobectomy: A Case Report of Successful Psychotherapeutic Intervention

Background

Over the last decades, brain surgery became a more frequently applied treatment for temporal lobe epilepsy (TLE). Despite its success, several studies found de-novo post-operative psychiatric symptoms in TLE surgery patients. Cognitive behavioural therapy is effective to treat brain healthy psychiatric patients but might not be translatable to patients with resections in emotion regulating networks as these areas seem to be essentially involved in successful psychotherapeutic treatment.

Methods

Here we report the case of a female patient with medically refractory medial temporal lobe epilepsy resulting in left anterior temporal lobectomy at age 35. Post operation she did not show adequate fearful response but at the same time manifested symptoms of a severe panic disorder. We investigated if this patient, despite lesions in emotion-behaviour brain circuits, can benefit from cognitive behavioural therapy.

Results

The intervention, customized to the specific resources and difficulties of the patient, was effective in stopping panic attacks and improving social functioning.

Conclusions

This case shows that MTL brain surgery patients may benefit from CBT and demonstrates the important and if yet still somewhat mysterious role of the amygdala in emotion regulation processes.

CA, Klingner CM. The Right Hemisphere Is Responsible for the Greatest Differences in Human Brain Response to High-Arousing Emotional versus Neutral Stimuli: A MEG Study

Studies investigating human brain response to emotional stimuli-particularly high-arousing versus neutral stimuli-have obtained inconsistent results. The present study was the first to combine magnetoencephalography (MEG) with the bootstrapping method to examine the whole brain and identify the cortical regions involved in this differential response. Seventeen healthy participants (11 females, aged 19 to 33 years; mean age, 26.9 years) were presented with high-arousing emotional (pleasant and unpleasant) and neutral pictures, and their brain responses were measured using MEG. When random resampling bootstrapping was performed for each participant, the greatest differences between high-arousing emotional and neutral stimuli during M300 (270-320 ms) were found to occur in the right temporo-parietal region. This finding was observed in response to both pleasant and unpleasant stimuli. The results, which may be more robust than previous studies because of bootstrapping and examination of the whole brain, reinforce the essential role of the right hemisphere in emotion processing.

Emotion and mood disorders associated with epilepsy

Epilepsy is a disorder characterized by recurrent seizures. Epilepsy can alter mood and emotions. Treatments for epilepsy can also alter mood and emotions. This chapter reviews the emotional changes that can occur before, during, and after a seizure, such as fear and anger, the interictal mood disorders associated with epilepsy, such as depression and anxiety, as well as alterations of emotional processing including comprehending and expressing emotional prosody and faces. The possible treatments of these emotional and mood disorders are also reviewed.

The effects of insular and mesiotemporal lesions on affective information processing: Preliminary evidence from patients with epilepsy surgery

Depressive symptoms and anxiety are common complaints in patients who have had epilepsy surgery. Recent studies have reported disturbances in emotional memory, facial and vocal emotion recognition, and affective learning after temporal lobe and/or insular resection for drug-resistant seizures, suggesting that these regions may be involved in emotional processes underlying psychological symptoms. The insula is a core component of the salience network and is thought to be involved in processing emotions such as disgust, and the role of mesial temporal lobe structures in affective processing is well established. However, to our knowledge, no study has yet investigated whether attentional processing of affective information is altered when these structures are resected as part of an epilepsy surgery. The present study examined the interference control capacity and attentional biases for emotional information in adult patients with epilepsy who underwent temporal lobe resections including the amygdala and hippocampus (n = 15) and/or partial or complete insular resections (n = 16). Patients were tested on an Emotional Stroop test and on a Dot-Probe task using fearful and disgusting pictures and were compared with a healthy control group (n = 30) matched for age, gender, and education. Repeated-measures analyses of variances revealed a significant effect of emotional words on color naming speed in the Emotional Stroop task among insular patients, which was not observed in the other groups. By contrast, the groups did not differ on Dot-Probe task performance. These preliminary findings suggest that insular damage may alter emotional interference control.

The credibility of acted screams: Implications for emotional communication research

Researchers have long relied on acted material to study emotional expression and perception in humans. It has been suggested, however, that certain aspects of natural expressions are difficult or impossible to produce voluntarily outside of their associated emotional contexts, and that acted expressions tend to be overly intense caricatures. From an evolutionary perspective, listeners' abilities to distinguish acted from natural expressions likely depend on the type of expression in question, the costs entailed in its production, and elements of receiver psychology. Here, we investigated these issues as they relate to human screams. We also examined whether listeners' abilities to distinguish acted from natural screams might vary as a function of individual differences in emotional processing and empathy. Using a forced-choice categorization task, we found that listeners could not distinguish acted from natural exemplars, suggesting that actors can produce dramatisations of screams resembling natural vocalisations. Intensity ratings did not differ between acted and natural screams, nor did individual differences in emotional processing significantly predict performance. Scream duration predicted both the probability that an exemplar was categorised as acted and the probability that participants classified that scream accurately. These findings are discussed with respect to potential evolutionary implications and their practical relevance to future research using acted screams.

Cross-classification of musical and vocal emotions in the auditory cortex

Whether emotions carried by voice and music are processed by the brain using similar mechanisms has long been investigated. Yet neuroimaging studies do not provide a clear picture, mainly due to lack of control over stimuli. Here, we report a functional magnetic resonance imaging (fMRI) study using comparable stimulus material in the voice and music domains-the Montreal Affective Voices and the Musical Emotional Bursts-which include nonverbal short bursts of happiness, fear, sadness, and neutral expressions. We use a multivariate emotion-classification fMRI analysis involving cross-timbre classification as a means of comparing the neural mechanisms involved in processing emotional information in the two domains. We find, for affective stimuli in the violin, clarinet, or voice timbres, that local fMRI patterns in the bilateral auditory cortex and upper premotor regions support above-chance emotion classification when training and testing sets are performed within the same timbre category. More importantly, classifier performance generalized well across timbre in cross-classifying schemes, albeit with a slight accuracy drop when crossing the voice-music boundary, providing evidence for a shared neural code for processing musical and vocal emotions, with possibly a cost for the voice due to its evolutionary significance.

Emotional Prosody Processing in Epilepsy: Some Insights on Brain Reorganization

Drug resistant epilepsy is one of the most complex, multifactorial and polygenic neurological syndrome. Besides its dynamicity and variability, it still provides us with a model to study brain-behavior relationship, giving cues on the anatomy and functional representation of brain function. Given that onset zone of focal epileptic seizures often affects different anatomical areas, cortical but limited to one hemisphere, this condition also let us study the functional differences of the left and right cerebral hemispheres. One lateralized function in the human brain is emotional prosody, and it can be a useful ictal sign offering hints on the location of the epileptogenic zone. Besides its importance for effective communication, prosody is not considered an eloquent domain, making resective surgery on its neural correlates feasible. We performed an Electronic databases search (Medline and PsychINFO) from inception to July 2017 for studies about prosody in epilepsy. The search terms included “epilepsy,” “seizure,” “emotional prosody,” and “vocal affect.” This review focus on emotional prosody processing in epilepsy as it can give hints regarding plastic functional changes following seizures (preoperatively), resection (post operatively), and also as an ictal sign enabling the assessment of dynamic brain networks. Moreover, it is argued that such reorganization can help to preserve the expression and reception of emotional prosody as a central skill to develop appropriate social interactions.

Impaired Emotion Recognition after Left Hemispheric Stroke: A Case Report and Brief Review of the Literature

Impaired recognition of emotion after stroke can have important implications for social competency, social participation, and consequently quality of life. We describe a case of left hemispheric ischemic stroke with impaired recognition of specifically faces expressing fear. Three months later, the patient's spouse reports that the patient was irritable and slow in communication, which may be caused by the impaired emotion recognition. The case is discussed in relation to the literature concerning emotion recognition and its neural correlates. Our case supports the notion that emotion recognition, including fear recognition, is regulated by a network of interconnected brain regions located in both hemispheres. We conclude that impaired emotion recognition is not uncommon after stroke and can be caused by dysfunction of this emotion-network.

Arousal in response to neutral pictures is modified in temporal lobe epilepsy

The objectives of the present study were to (i) better characterize visual emotional experience in patients with temporal lobe epilepsy (TLE), (ii) identify clinical risk factors that might be predictive of a change in emotional experience, and (iii) study the relationships between emotional experience and psychobehavioral/quality-of-life factors. Fifty patients with TLE and fifty matched controls evaluated the emotional content of unpleasant, pleasant, and neutral pictures with respect to their valence (unpleasant-to-pleasant) and arousal (low-to-high) levels. Demographic, cognitive, and psychobehavioral data were recorded for all participants, and clinical data and factors related to quality of life were also collected for patients with TLE. There were no significant differences between the group with TLE and the control group in terms of valence evaluations. However, arousal scores for neutral pictures were significantly higher in patients with TLE than in controls. There was also a nonsignificant trend towards lower arousal scores for pleasant pictures in patients with TLE than in controls. Although none of the recorded clinical factors were found to be related to emotional experience, the level of apathy was predictive of greater arousal experience for neutral pictures in patients with TLE. In conclusion, emotional experience appears to be modified in TLE and might be related to apathy. Changes in emotional experience should be taken into account in studies in which neutral stimuli are used to establish a baseline level when assessing emotional and cognitive processing.

Social information processing following resection of the insular cortex

The insula has been implicated in social cognition and empathy in several neuroimaging paradigms. Impairments in social information processing, including specific deficits in disgust recognition, have been described following isolated insular damage, although the evidence remains limited to a few case studies. The present study examines social cognition and empathy in a group of fifteen patients for whom the insula was removed as part of their epilepsy surgery. These patients were compared to a lesion-control group of 15 epileptic patients who had a surgery in the anterior temporal lobe that spared the insula, and to 20 healthy volunteers matched on age, sex, and education. Participants were assessed on an Emotion Recognition Task (ERT), the Reading the Mind in the Eyes test, and a self-administered empathy questionnaire. Patients who underwent insular resection showed poorer ability to recognize facial expressions of emotions and had lower scores of perspective taking on the empathy questionnaire than healthy controls. Using results from healthy controls as normative data, emotion recognition deficits were more frequent in insular patients than in both other groups. Specific emotion analyses revealed impairments in fear recognition in both groups of patients, whereas happiness and surprise recognition was only impaired in patients with insular resection. There was no evidence for a deficit in disgust recognition. The findings suggest that unilateral damage to the operculo-insular region may be associated with subtle impairments in emotion recognition, and provide further clinical evidence of a role of the insula in empathic processes. However, the description of 15 consecutive cases of insula-damaged patients with no specific deficit in disgust recognition seriously challenges the assumptions, based on previous case reports, that the insula is specifically involved in disgust processing.

Can you hear what I feel? A validated prosodic set of angry, happy, and neutral Italian pseudowords

This contribution aims to establish a set of validated vocal Italian pseudowords that convey three emotional tones (angry, happy, and neutral) for prosodic emotional processing research. We elaborated the materials by following a series of specific steps. First, we tested the valence of a set of written pseudowords generated by specific software. Two Italian actors (male and female) then recorded the resulting subset of linguistically legal and neutral pseudowords in three emotional tones. Finally, on the basis of the results of independent ratings of emotional intensity, we selected a set of 30 audio stimuli expressed in each of the three different emotions. Acoustic analyses indicated that the prosodic indexes of fundamental frequency, vocal intensity, and speech rate anchored individual perceptions of the emotions expressed. Finally, the acoustic profile of the set of emotional stimuli confirmed previous findings. The happy tone stimuli showed high f0 values, high intensity, high pitch variability, and a faster speech rate. The angry tone stimuli were also characterized by high f0 and intensity, but by relatively smaller pitch variability and a lower speech rate. This last profile echoes the description of "cold anger." This new set of prosodic emotion stimuli will constitute a useful resource for future research that requires emotional prosody materials. It could be used both for Italian and for cross-language studies.

Abolition of lifelong specific phobia: a novel therapeutic consequence of left mesial temporal lobectomy

Numerous imaging studies have confirmed the amygdala as prominent within a neural network mediating specific phobia, including arachnophobia. We report the case of a patient in whom arachnophobia was abolished after left temporal mesial lobectomy, with unchanged fear responses to other stimuli. The phenomenon of abolition of specific phobia after amygdala removal has not, to our knowledge, been previously reported.

The affective value of faces in patients achieving long-term seizure freedom after temporal lobectomy

We investigated different aspects of facial expression evaluation in a homogeneous cohort of 42 seizure-free patients with 5 or more years of follow-up after temporal lobectomy (TL), with the aim of further characterizing the impairment in emotion and social cognition among patients. A group of healthy subjects matched for sex, age, and education served as controls. Four tasks of facial expression evaluation were used: (a) facial expression recognition, (b) rating of the intensity of facial expression, and (c) rating of valence (pleasantness) and (d) rating of arousal induced by facial expressions. Patients had a worse performance in the recognition task for all negative emotions, while no differences in intensity ratings were found. They also reported lower arousal ratings than controls for faces showing fear, anger, disgust, and neutral expressions, as well as lower valence ratings for all facial expressions except those showing happiness. Longer epilepsy duration before TL was negatively associated with ratings of arousal and intensity and positively associated with valence ratings for fearful facial expressions. This study showed that patients who become seizure-free after TL present long-term deficits in several aspects of facial expression evaluation. Longitudinal, prospective studies are needed to evaluate if social cognition improves or declines after TL.

Multimodal emotion perception after anterior temporal lobectomy (ATL)

In the context of emotion information processing, several studies have demonstrated the involvement of the amygdala in emotion perception, for unimodal and multimodal stimuli. However, it seems that not only the amygdala, but several regions around it, may also play a major role in multimodal emotional integration. In order to investigate the contribution of these regions to multimodal emotion perception, five patients who had undergone unilateral anterior temporal lobe resection were exposed to both unimodal (vocal or visual) and audiovisual emotional and neutral stimuli. In a classic paradigm, participants were asked to rate the emotional intensity of angry, fearful, joyful, and neutral stimuli on visual analog scales. Compared with matched controls, patients exhibited impaired categorization of joyful expressions, whether the stimuli were auditory, visual, or audiovisual. Patients confused joyful faces with neutral faces, and joyful prosody with surprise. In the case of fear, unlike matched controls, patients provided lower intensity ratings for visual stimuli than for vocal and audiovisual ones. Fearful faces were frequently confused with surprised ones. When we controlled for lesion size, we no longer observed any overall difference between patients and controls in their ratings of emotional intensity on the target scales. Lesion size had the greatest effect on intensity perceptions and accuracy in the visual modality, irrespective of the type of emotion. These new findings suggest that a damaged amygdala, or a disrupted bundle between the amygdala and the ventral part of the occipital lobe, has a greater impact on emotion perception in the visual modality than it does in either the vocal or audiovisual one. We can surmise that patients are able to use the auditory information contained in multimodal stimuli to compensate for difficulty processing visually conveyed emotion.

The "Musical Emotional Bursts": a validated set of musical affect bursts to investigate auditory affective processing

The Musical Emotional Bursts (MEB) consist of 80 brief musical executions expressing basic emotional states (happiness, sadness and fear) and neutrality. These musical bursts were designed to be the musical analog of the Montreal Affective Voices (MAV)—a set of brief non-verbal affective vocalizations portraying different basic emotions. The MEB consist of short (mean duration: 1.6 s) improvisations on a given emotion or of imitations of a given MAV stimulus, played on a violin (10 stimuli × 4 [3 emotions + neutral]), or a clarinet (10 stimuli × 4 [3 emotions + neutral]). The MEB arguably represent a primitive form of music emotional expression, just like the MAV represent a primitive form of vocal, non-linguistic emotional expression. To create the MEB, stimuli were recorded from 10 violinists and 10 clarinetists, and then evaluated by 60 participants. Participants evaluated 240 stimuli [30 stimuli × 4 (3 emotions + neutral) × 2 instruments] by performing either a forced-choice emotion categorization task, a valence rating task or an arousal rating task (20 subjects per task); 40 MAVs were also used in the same session with similar task instructions. Recognition accuracy of emotional categories expressed by the MEB (n:80) was lower than for the MAVs but still very high with an average percent correct recognition score of 80.4%. Highest recognition accuracies were obtained for happy clarinet (92.0%) and fearful or sad violin (88.0% each) MEB stimuli. The MEB can be used to compare the cerebral processing of emotional expressions in music and vocal communication, or used for testing affective perception in patients with communication problems.

Unimpaired discrimination of fearful prosody after amygdala lesion

Prosody (i.e. speech melody) is an important cue to infer an interlocutor's emotional state, complementing information from face expression and body posture. Inferring fear from face expression is reported as impaired after amygdala lesions. It remains unclear whether this deficit is specific to face expression, or is a more global fear recognition deficit. Here, we report data from two twins with bilateral amygdala lesions due to Urbach-Wiethe syndrome and show they are unimpaired in a multinomial emotional prosody classification task. In a two-alternative forced choice task, they demonstrate increased ability to discriminate fearful and neutral prosody, the opposite of what would be expected under an hypothesis of a global role for the amygdala in fear recognition. Hence, we provide evidence that the amygdala is not required for recognition of fearful prosody.

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Prosody recognition is assessed in two twin sisters with amygdala lesions due to Urbach–Wiethe syndrome.

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In a multinomial classification task, there is no impairment.

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In a two-alternative forced choice task, patients discriminate fearful and neutral prosody better than a control sample.

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This study provides evidence that the amygdala has no general role in fear recognition.

Injured brain regions associated with anxiety in Vietnam veterans

Anxiety negatively affects quality of life and psychosocial functioning. Previous research has shown that anxiety symptoms in healthy individuals are associated with variations in the volume of brain regions, such as the amygdala, hippocampus, and the bed nucleus of the stria terminalis. Brain lesion data also suggests the hemisphere damaged may affect levels of anxiety. We studied a sample of 182 male Vietnam War veterans with penetrating brain injuries, using a semi-automated voxel-based lesion-symptom mapping (VLSM) approach. VLSM reveals significant associations between a symptom such as anxiety and the location of brain lesions, and does not require a broad, subjective assignment of patients into categories based on lesion location. We found that lesioned brain regions in cortical and limbic areas of the left hemisphere, including middle, inferior and superior temporal lobe, hippocampus, and fusiform regions, along with smaller areas in the inferior occipital lobe, parahippocampus, amygdala, and insula, were associated with increased anxiety symptoms as measured by the Neurobehavioral Rating Scale (NRS). These results were corroborated by similar findings using Neuropsychiatric Inventory (NPI) anxiety scores, which supports these regions' role in regulating anxiety. In summary, using a semi-automated analysis tool, we detected an effect of focal brain damage on the presentation of anxiety. We also separated the effects of brain injury and war experience by including a control group of combat veterans without brain injury. We compared this control group against veterans with brain lesions in areas associated with anxiety, and against veterans with lesions only in other brain areas.

Current Emotion Research in Behavioral Neuroscience: The Role(s) of the Amygdala

Substantial advances in our understanding of the neural bases of emotional processing have been made over the past decades. Overall, studies in humans and other animals highlight the key role of the amygdala in the detection and evaluation of stimuli with affective value. Nonetheless, contradictory findings have been reported, especially in terms of the exact role of this structure in the processing of different emotions, giving rise to different neural models of emotion. For instance, although the amygdala has traditionally been considered as exclusively involved in fear (and possibly anger), more recent work suggests that it may be important for processing other types of emotions, and even nonemotional information. A review of the main findings in this field is presented here, together with some of the hypotheses that have been put forward to interpret this literature and explain its inconsistencies.

Influence of Moyamoya disease on psychopathological abnormality in young males in Korea: analysis of multiphasic personal inventory test

We analyzed the results of a multiphasic personal inventory test to confirm whether Moyamoya disease (MMD) affects the psychopathology in a group of young male Koreans. The authors manually reviewed the results of the Korean military multiphasic personal inventory (KMPI) for the examination of conscripts in Korea from July 2006 to May 2010. The normal volunteers group (N = 200) was composed of those males who do not have any brain disease or brain trauma. The MMD group (N = 37) was composed of those with MMD. There were more abnormal results in the MMD group (32.4 %) than in the normal volunteers group (13.0 %, p < 0.001). Results of the Neurosis Set showed that the anxiety scale, the depression scale and the somatization scale were more increased in the MMD group than that in the normal volunteer group (p = 0.014, 0.002 and 0.006, respectively). Results of the Social Relation Set showed that the aggregation scale was more increased in the MMD group than that in the normal volunteers group (p = 0.017). Young males with MMD may have more tendencies to have abnormal results of a multiphasic personal inventory test as compared to that of normal volunteers, suggesting that MMD may cause psychopathology in young Korean males.

Music and epilepsy: a critical review

The effect of music on patients with epileptic seizures is complex and at present poorly understood. Clinical studies suggest that the processing of music within the human brain involves numerous cortical areas, extending beyond Heschl's gyrus and working within connected networks. These networks could be recruited during a seizure manifesting as musical phenomena. Similarly, if certain areas within the network are hyperexcitable, then there is a potential that particular sounds or certain music could act as epileptogenic triggers. This occurs in the case of musicogenic epilepsy, whereby seizures are triggered by music. Although it appears that this condition is rare, the exact prevalence is unknown, as often patients do not implicate music as an epileptogenic trigger and routine electroencephalography does not use sound in seizure provocation. Music therapy for refractory epilepsy remains controversial, and further research is needed to explore the potential anticonvulsant role of music. Dopaminergic system modulation and the ambivalent action of cognitive and sensory input in ictogenesis may provide possible theories for the dichotomous proconvulsant and anticonvulsant role of music in epilepsy. The effect of antiepileptic drugs and surgery on musicality should not be underestimated. Altered pitch perception in relation to carbamazepine is rare, but health care professionals should discuss this risk or consider alternative medication particularly if the patient is a professional musician or native-born Japanese. Studies observing the effect of epilepsy surgery on musicality suggest a risk with right temporal lobectomy, although the extent of this risk and correlation to size and area of resection need further delineation. This potential risk may bring into question whether tests on musical perception and memory should form part of the preoperative neuropsychological workup for patients embarking on surgery, particularly that of the right temporal lobe.