1
|
Li W, Seyal M. Reading Epilepsy and Language Processing: A Proposed Role for Semantic Salience. J Clin Neurophysiol 2023; 40:e1-e5. [PMID: 36308758 DOI: 10.1097/wnp.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
SUMMARY Reading epilepsy is a relatively rare reflex epilepsy syndrome that typically presents as orofacial reflex myoclonus triggered by reading. Seizures are thought to be because of activation of hyperexcitable language-related pathways in the dominant hemisphere that subsequently spreads to adjacent motor cortices. More difficult reading tasks are thought to be more provocative of seizures regardless of semantic understanding of the text. The authors sought to better characterize the role of text difficulty and comprehension in triggering seizures in a 27-year-old patient with reading epilepsy. As a part of his epilepsy monitoring unit admission, the patient underwent a series of reading trials with increasing semantic salience and/or difficulty, including pseudo-reading of colors and foreign-language texts, which demonstrated a positive correlation between spike count and clinical events and increasing semantic salience. This suggests that our novel reading task may be able to differentiate between different processes in the reading pathway and that increased semantic relevance of the text, rather than increased difficulty per se, can be associated with increased seizures in reading epilepsy. The authors theorize that this may be associated with his atypical (nondominant) right hemispheric seizure focus and propose that further study of patients with reading epilepsy syndrome may help elucidate the neurobiological networks involved in reading and language processing.
Collapse
Affiliation(s)
- Wentao Li
- Department of Neurology, University of California, Sacramento, California, U.S.A.; and
- Division of Behavioral Neurology, Department of Neurology, Mayo Clinic, Minnesota, U.S.A
| | - Masud Seyal
- Department of Neurology, University of California, Sacramento, California, U.S.A.; and
| |
Collapse
|
2
|
Bratu IF, Nica AE, Oane I, Daneasa A, Stoica S, Barborica A, Mindruta I. Musicogenic seizures in temporal lobe epilepsy: Case reports based on ictal source localization analysis. Front Neurol 2023; 14:1072075. [PMID: 36891471 PMCID: PMC9987853 DOI: 10.3389/fneur.2023.1072075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/17/2023] [Indexed: 02/22/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Ionut-Flavius Bratu
- Epilepsy Monitoring Unit, Neurology Department, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Adriana Elena Nica
- Intensive Care Unit, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Irina Oane
- Epilepsy Monitoring Unit, Neurology Department, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Andrei Daneasa
- Epilepsy Monitoring Unit, Neurology Department, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Sergiu Stoica
- Neurosurgery Department, Brain Institute, Monza Hospital, Bucharest, Romania
| | | | - Ioana Mindruta
- Epilepsy Monitoring Unit, Neurology Department, University Emergency Hospital Bucharest, Bucharest, Romania.,Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
3
|
Wired for sound: The effect of sound on the epileptic brain. Seizure 2022; 102:22-31. [PMID: 36179456 DOI: 10.1016/j.seizure.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/08/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Sound waves are all around us resonating at audible and inaudible frequencies. Our ability to hear is crucial in providing information and enabling interaction with our environment. The human brain generates neural oscillations or brainwaves through synchronised electrical impulses. In epilepsy these brainwaves can change and form rhythmic bursts of abnormal activity outwardly appearing as seizures. When two waveforms meet, they can superimpose onto one another forming constructive, destructive or mixed interference. The effects of audible soundwaves on epileptic brainwaves has been largely explored with music. The Mozart Sonata for Two Pianos in D major, K. 448 has been examined in a number of studies where significant clinical and methodological heterogeneity exists. These studies report variable reductions in seizures and interictal epileptiform discharges. Treatment effects of Mozart Piano Sonata in C Major, K.545 and other composer interventions have been examined with some musical exposures, for example Hayden's Symphony No. 94 appearing pro-epileptic. The underlying anti-epileptic mechanism of Mozart music is currently unknown, but interesting research is moving away from dopamine reward system theories to computational analysis of specific auditory parameters. In the last decade several studies have examined inaudible low intensity focused ultrasound as a neuro-modulatory intervention in focal epilepsy. Whilst acute and chronic epilepsy rodent model studies have consistently demonstrated an anti-epileptic treatment effect this is yet to be reported within large scale human trials. Inaudible infrasound is of concern since at present there are no reported studies on the effects of exposure to infrasound on epilepsy. Understanding the impact of infrasound on epilepsy is critical in an era where sustainable energies are likely to increase exposure.
Collapse
|
4
|
Park C, Sinha SR, Southwell DG. Laser ablative treatment of musicogenic epilepsy arising from dominant mesial temporal lobe: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE2295. [PMID: 35733825 PMCID: PMC9204930 DOI: 10.3171/case2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Musicogenic epilepsy (ME) is a rare reflex epilepsy in which seizures are triggered by musical stimuli. Prior descriptions of ME have suggested localization to the nondominant temporal lobe, primarily in neocortex. Although resection has been described as a treatment for ME, other surgical modalities, such as laser ablation, may effectively disrupt seizure networks in ME while incurring comparatively lower risks of morbidity. The authors described the use of laser ablation to treat ME arising from the dominant mesial temporal structures. OBSERVATIONS A 37-year-old woman with a 15-year history of drug-resistant ME was referred for surgical evaluation. Her seizures were triggered by specific musical content and involved behavioral arrest, repetitive swallowing motions, and word incomprehension. Diagnostic studies, including magnetic resonance imaging, single-photon emission computed tomography, magnetoencephalography, Wada testing, and stereoelectroencephalography, indicated seizure onset in the left (dominant) mesial temporal lobe. Laser interstitial thermal therapy was used to ablate the left mesial seizure onset zone. The patient was discharged on postoperative day two. At 18-month follow-up, she was seizure-free with no posttreatment neurological deficits. LESSONS Laser ablation can be an effective treatment option for well-localized forms of ME, particularly when seizures originate from the dominant mesial temporal lobe.
Collapse
Affiliation(s)
| | - Saurabh R. Sinha
- Neurology, Duke University Medical Center, Durham, North Carolina
| | | |
Collapse
|
5
|
Al-Attas AA, Al Anazi RF, Swailem SK. Musicogenic reflex seizure with positive antiglutamic decarboxylase antibody: A case report. Epilepsia Open 2021; 6:607-610. [PMID: 34218519 PMCID: PMC8408607 DOI: 10.1002/epi4.12518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 06/25/2021] [Accepted: 07/01/2021] [Indexed: 11/07/2022] Open
Abstract
The association of musicogenic epilepsy (ME) with antibodies against glutamic decarboxylase (GAD) supports autoimmune workups for these patients. No appropriate treatment has been established for ME; therefore, immunotherapy should be considered for patients who become drug-resistant. The connection between neurological manifestations and antibodies against GAD, a rate-limiting enzyme that helps create the inhibitory neurotransmitter gamma-aminobutyric acid, has been well established. Furthermore, a strong correlation has been found between ME and the temporal lobe. However, its connection with anti-GAD antibodies is still unclear. This paper reports on a 50-year-old right-handed female who has had ME symptoms for 14 years and been found to be anti-GAD antibody-positive. Therefore, we will elaborate on the relation between ME and anti-GAD antibodies.
Collapse
Affiliation(s)
- Alawi A Al-Attas
- Department of Adult Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Riyam F Al Anazi
- Department of Adult Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.,Department of Pediatric Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Saleh K Swailem
- Department of Adult Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.,Department of Adult Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
6
|
Abstract
Reflex seizures (RS) are epileptic events that are objectively and consistently elicited in response to a specific afferent stimulus or by an activity of the patient. The specific stimulus can be a variety of heterogenous intrinsic or extrinsic factors, ranging from the simple to the complex, such as flashing lights or reading a book. These seizures can take a variety of forms, comprising either general or focal onset, with or without secondary generalization. Reflex epilepsies (RE) are classified as a specific syndrome in which all epileptic seizures are precipitated by sensory stimuli. The few designated RE include idiopathic photosensitive occipital lobe epilepsy, other visual sensitive epilepsies, primary reading epilepsy, and startle epilepsy. RS that occurs within other focal or generalized epilepsy syndromes that are associated with distinct spontaneous seizures are classified by the overarching seizure type. Most patients experience spontaneous seizures along with their provoked events. RS originate from stimulation of functional anatomic networks normally functioning for physiological activities, that overlap or coincide with regions of cortical hyperexcitability. Generalized RS typically occur within the setting of IGEs and should be considered as focal seizures with quick secondary generalization via cortico-cortical or cortico-reticular pathways. In aggregate, activation of a critical neuronal mass, supported and sustained by cortico-subcortical and thalamocortical pathways eventually result in a seizure. Treatment includes antiseizure medication, commonly valproate or levetiracetam, along with lifestyle modifications, and when amenable, surgical intervention. High clinical suspicion and careful history taking must be employed in all epilepsy patients to identify reflex triggers.
Collapse
Affiliation(s)
- Samrina Hanif
- 1Department of Neurology, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA
| | - Shane T Musick
- 2Department of Neurosurgery, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA
| |
Collapse
|
7
|
Cenobamate, a Sodium Channel Inhibitor and Positive Allosteric Modulator of GABA A Ion Channels, for Partial Onset Seizures in Adults: A Comprehensive Review and Clinical Implications. Neurol Int 2021; 13:252-265. [PMID: 34207493 PMCID: PMC8293325 DOI: 10.3390/neurolint13020026] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/19/2021] [Accepted: 05/29/2021] [Indexed: 12/16/2022] Open
Abstract
Medical management of epilepsy seeks to eliminate or to reduce the frequency of seizures, help patients maintain a normal lifestyle, and maintain psychosocial and occupational activities, while avoiding the negative side effects of long-term treatment. Current FDA approved drugs have been shown to have similar efficacy; however, they all share a commonality of having side effects that have the potential to significantly reduce a patient’s quality of life. Cenobamate, a newly-FDA approved drug used to treat partial-onset seizures in adult patients, has demonstrated promise in that it works on two proposed mechanisms that are commonly associated with epilepsy. Cenobamate acts as a positive allosteric modulator of the GABAA ion channels and is effective in reducing repetitive neuronal firing by inhibition of voltage-gated sodium channels, although the complete mechanism of action is currently unknown. The efficacy of Cenobamate with its low toxicity and adverse drug reaction profile emphasizes the need to further evaluate antiepileptic therapies containing sulfamoylphenyl and/or carbamate moieties in their chemical structure. Recent studies have found more patients to be seizure free during the maintenance period when compared to placebo. The most common side effects reported in with Cenobamate are somnolence, dizziness, headache, nausea, and fatigue. There are currently ongoing phase III studies looking to further evaluate the long-term benefits of Cenobamate and investigate adverse events.
Collapse
|
8
|
Smith KM, Zalewski NL, Budhram A, Britton JW, So E, Cascino GD, Ritaccio AL, McKeon A, Pittock SJ, Dubey D. Musicogenic epilepsy: Expanding the spectrum of glutamic acid decarboxylase 65 neurological autoimmunity. Epilepsia 2021; 62:e76-e81. [PMID: 33764529 DOI: 10.1111/epi.16888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 01/01/2023]
Abstract
The objective of this study was to describe serological association of musicogenic epilepsy and to evaluate clinical features and outcomes of seropositive cases. Through retrospective chart review, musicogenic epilepsy patients were identified. Among 16 musicogenic epilepsy patients, nine underwent autoantibody evaluations and all had high-titer glutamic acid decarboxylase 65-immunoglobulin G (GAD65-IgG; >20 nmol·L-1 , serum, normal ≤ .02 nmol·L-1 , eight women). Median GAD65-IgG serum titer was 294 nmol·L-1 (20.3-3005 nmol·L-1 ), and median cerebrospinal fluid titer (n = 4) was 14.7 nmol·L-1 . All patients had temporal lobe epilepsy, and bitemporal epileptiform abnormalities were common. Right temporal lobe seizures were most frequently captured when seizures were induced by music on electroencephalogram (3/4; 75%). Intravenous (IV) methylprednisolone and/or IV Ig (IVIG) was utilized in four patients, with one having greater than 50% reduction. Rituximab (n = 2) and mycophenolate (n = 1) were ineffective. Two patients underwent right temporal lobe resections but continued to have seizures. Vagus nerve stimulation was effective at reducing seizures in one patient by 50%, and an additional patient was seizure-free by avoiding provoking music. Right temporal lobe epilepsy was more common among patients with musicogenic epilepsy when compared to nonmusicogenic GAD65 epilepsies (n = 71, 89% vs. 47%, p = .03). GAD65-IgG should be tested in patients with musicogenic epilepsy, given implications for management and screening for comorbid autoimmune conditions.
Collapse
Affiliation(s)
- Kelsey M Smith
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Adrian Budhram
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| | | | - Elson So
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
9
|
Bhandari AS, Gourie-Devi M, Kumar P, Khanna L. A Case of Musicogenic Epilepsy. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0041-1725993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractMusicogenic epilepsy is a relatively rare form of epilepsy characterized by seizures triggered by specific music experiences, with an estimated prevalence of 1/10,000,000 population. In this article, we reported a case of 12-year-old boy patient with a history of recent onset focal seizures associated with an aura of formed visual hallucinations, feeling of familiarity (déjà vu), and impending fear lasting for seconds to a minute followed by eye blinking, oral automatisms, and unresponsiveness for almost 15 minutes. These episodes, most often, were provoked by music. Video electroencephalogram (EEG) done in our institute was suggestive of reflex musicogenic epilepsy arising from the left anterior temporal lobe. Magnetic resonance imaging of the brain 3T with epilepsy protocol confirmed video EEG findings, with an abnormal signal intensity in the left hippocampal and mesial temporal lobe. Treatment included lifestyle modification and antiepileptic drugs.
Collapse
Affiliation(s)
| | | | - Praveen Kumar
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Laxmi Khanna
- Department of Neurophysiology, Sir Ganga Ram Hospital, New Delhi, India
| |
Collapse
|
10
|
Spatio-temporal dynamics of interictal activity in musicogenic epilepsy: Two case reports and a systematic review of the literature. Clin Neurophysiol 2020; 131:2393-2401. [PMID: 32828042 DOI: 10.1016/j.clinph.2020.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/18/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore neurophysiological features of musicogenic epilepsy (ME), discussing experimental findings in the framework of a systematic review on ME. METHODS Two patients with ME underwent high-density-electroencephalography (hd-EEG) while listening to ictogenic songs. In one case, musicogenic seizures were elicited. Independent component analysis (ICA) was applied to hd-EEG, and components hosting interictal and ictal elements were identified and localized. Finally, the temporal dynamics of spike-density was studied relative to seizures. All findings were compared against the results of a systematic review on ME, collecting 131 cases. RESULTS Interictal spikes appeared isolated in specific fronto-temporal independent components, whose cortical generators were located in the anterior temporal and inferior frontal lobe. In the patient undergoing seizure, ictal discharge relied in the same component, with the interictal spike-density decreasing before the seizure onset. CONCLUSION Our study shows how ICA can isolate neurophysiological features of ictal and interictal discharges in ME, highlighting a fronto-temporal localization and a suppression of spike-density preceding the seizure onset. SIGNIFICANCE While the localization of ME activity could indicate which aspect within the musical stimulus might trigger musicogenic seizures for each patient, the study of ME dynamics could contribute to the development of models for seizure-prediction and their validation.
Collapse
|
11
|
Pelliccia V, Villani F, Gozzo F, Gnatkovsky V, Cardinale F, Tassi L. Musicogenic epilepsy: A Stereo-electroencephalography study. Cortex 2019; 120:582-587. [PMID: 30837152 DOI: 10.1016/j.cortex.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/02/2018] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Abstract
Musicogenic epilepsy is rare focal epilepsy in which seizures are triggered by music. Both spontaneous and reflexes seizures may occur. To date there are limited data about this epilepsy, particularly about its etiopathogenesis. We report the clinical, neurophysiological and imaging data about musicogenic epilepsy in a patient who underwent Stereo-electroencephalography (SEEG) study. A 27 year-old right-handed woman suffering from drug-resistant epilepsy since the age of 17 years, was evaluated for surgery. She had weekly seizures characterized by an unpleasant ascending gastric sensation, tachycardia, occasionally late oro-alimentary automatisms, déjà-vu and vomiting. Only during longer seizures a partial loss of awareness was reported. Interestingly, familiar songs triggered seizures. Rarely, she had spontaneous seizures with the same features. The ictal EEG onset appeared to be right temporal, but there was seizure propagation to suprasylvian areas. Brain MRI was negative. A SEEG implantation was performed to study the right temporo-perisylvian regions. SEEG data clearly indicated the antero-mesial temporal regions as origin of the seizures, without any spread to other close or distant cortical areas. Right temporal antero-mesial resection was performed 24 months ago and the patient is seizure-free since surgery. Neuropathology was uninformative. SEEG data highlighted the hypothesis regarding a temporo-mesial emotional-mnesic network triggered by particular music with an affective component for the patient. The primary auditory cortex and lateral mid-posterior temporal and extratemporal cortices were not involved. Different triggers as mentally singing and hearing the music can induce seizure as well as electrical stimulation in the mesial temporal structures.
Collapse
Affiliation(s)
| | - Flavio Villani
- Epilepsy Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milano, Italy
| | - Francesca Gozzo
- C. Munari Epilepsy Surgery Centre, Ospedale Niguarda, Milano, Italy
| | - Vadym Gnatkovsky
- Epilepsy Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milano, Italy
| | | | - Laura Tassi
- C. Munari Epilepsy Surgery Centre, Ospedale Niguarda, Milano, Italy.
| |
Collapse
|
12
|
Randhawa J, Hrazdil CT, Hassan I. Affect-induced reflex seizures (AIRS): A case series based on a systematic literature review. Epilepsy Behav 2019; 92:18-25. [PMID: 30599458 DOI: 10.1016/j.yebeh.2018.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/17/2018] [Accepted: 10/26/2018] [Indexed: 11/26/2022]
Abstract
Seizures are commonly thought to occur in a spontaneous, unpredictable manner. However, it is well-established that a subset of patients with epilepsy can experience reflex seizures that are consistently elicited by a specific stimulus. While various forms of reflex epilepsy have been documented in the literature, acute affective states have not been commonly described as a potential reflex seizure trigger. We performed a systematic literature review to determine if acute emotional states can trigger reflex seizures. We included any case in which reflex seizures repeatedly occurred in response to a patient-specific stimulus that was reported as emotionally relevant by the authors. This yielded our case series of ten patients who have been described to have reflex seizures in response to emotional stimuli. We characterized features of these cases including the following: age, gender, developmental and psychiatric history, seizure semiology and duration, emotional triggers, other reflex triggers, relationship between reflex triggers and seizures, investigations, localization, final diagnosis, treatment, and outcome. Considerable variability was found between cases. A trend toward limbic seizure semiology with psychic aura originating in networks involved in emotional processing was noted, with temporal lobe epilepsy being the most common, although without clear laterality or gender predominance. In addition, the report of a significant life stressor occurring at epilepsy onset in three of ten patients as well as the initial suspicion that reflex epileptic seizures were psychogenic in three cases both emphasize the role of electroencephalography in assessment of such presentations to avoid missing a diagnosis of epilepsy. Findings from these ten cases suggest that a patient-specific affective stimulus may trigger reflex seizures in a subset of patients, and that this could be underrecognized or mislabeled as nonepileptic. We encourage future studies with larger numbers to further characterize this phenomenon. Insights gained may enhance our understanding of seizure localization and bear potential treatment implications.
Collapse
Affiliation(s)
- Jason Randhawa
- Division of Neurology, The University of British Columbia, Vancouver, British Columbia, V6T 2B5, Canada
| | - Chantelle T Hrazdil
- Division of Neurology, The University of British Columbia, Vancouver, British Columbia, V6T 2B5, Canada; Vancouver General Hospital Epilepsy Program, Gordon and Leslie Diamond Health Care Centre, 8257 - 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Islam Hassan
- Vancouver General Hospital Epilepsy Program, Gordon and Leslie Diamond Health Care Centre, 8257 - 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada; University of British Columbia Neuropsychiatry Program, Detwiller Pavilion, UBC Hospital, 2255 Wesbrook Mall, Vancouver, British Columbia, V6T 2A1, Canada.
| |
Collapse
|
13
|
Arias M. Neurology of ecstatic religious and similar experiences: ecstatic, orgasmic, and musicogenic seizures. Stendhal syndrome and autoscopic phenomena. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2016.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
14
|
Abstract
INTRODUCTION There is growing awareness that reflex epileptic seizures offer unique insight into natural seizure generation in humans. In the last years, focus has mostly been on reflex seizures in generalized epilepsies whereas a comprehensive review of their role in focal epilepsies has been missing. Areas covered: This paper reviews reflex seizures strictly in focal epilepsies, not including focal reflex seizures in system epilepsies that also exist. They were categorized according to their triggers which can be sensory or cognitive, simple or complex. Numerous diverse conditions exist some of which are much better investigated than others. They required separate individual literature search in PubMed. Where recent review papers exist, it refers to these, but several conditions have never been reviewed, and here it refer to and discusses original reports. Miscellaneous case reports were only exceptionally included when they contributed aspects otherwise missing. Expert commentary: Research on focal reflex seizures with advanced methods of imaging and neurophysiology to elucidate mechanisms of focal ictogenesis will probably be rapidly increasing and will soon provide much new insight. Sensory and cognitive inhibition, i.e. the counterpart of reflex ictogenesis, is promising but needs more structured and controlled research to establish robust therapeutic approaches.
Collapse
Affiliation(s)
- Rūta Mameniškienė
- a Department of Neurology, Institute of Clinical Medicine , Center for Neurology, Vilnius University , Vilnius , Lithuania
| | - Peter Wolf
- b Danish Epilepsy Centre , Dianalund , Denmark.,c Serviço de Neurologia, Departamento de Clínica Médica , Hospital Universitário, Universidade Federal de Santa Catarina (UFSC) , Florianópolis , SC , Brazil
| |
Collapse
|
15
|
Tseng WEJ, Lim SN, Chen LA, Jou SB, Hsieh HY, Cheng MY, Chang CW, Li HT, Chiang HI, Wu T. Correlation of vocals and lyrics with left temporal musicogenic epilepsy. Ann N Y Acad Sci 2018; 1423:188-197. [PMID: 29542128 DOI: 10.1111/nyas.13594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/19/2017] [Accepted: 12/11/2017] [Indexed: 01/10/2023]
Abstract
Whether the cognitive processing of music and speech relies on shared or distinct neuronal mechanisms remains unclear. Music and language processing in the brain are right and left temporal functions, respectively. We studied patients with musicogenic epilepsy (ME) that was specifically triggered by popular songs to analyze brain hyperexcitability triggered by specific stimuli. The study included two men and one woman (all right-handed, aged 35-55 years). The patients had sound-triggered left temporal ME in response to popular songs with vocals, but not to instrumental, classical, or nonvocal piano solo versions of the same song. Sentimental lyrics, high-pitched singing, specificity/familiarity, and singing in the native language were the most significant triggering factors. We found that recognition of the human voice and analysis of lyrics are important causal factors in left temporal ME and provide observational evidence that sounds with speech structure are predominantly processed in the left temporal lobe. A literature review indicated that language-associated stimuli triggered ME in the left temporal epileptogenic zone at a nearly twofold higher rate compared with the right temporal region. Further research on ME may enhance understanding of the cognitive neuroscience of music.
Collapse
Affiliation(s)
- Wei-En J Tseng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Program in Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lu-An Chen
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shuo-Bin Jou
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsiang-Yao Hsieh
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Han-Tao Li
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
16
|
Falip M, Rodriguez‐Bel L, Castañer S, Miro J, Jaraba S, Mora J, Bas J, Carreño M. Musicogenic reflex seizures in epilepsy with glutamic acid decarbocylase antibodies. Acta Neurol Scand 2018; 137:272-276. [PMID: 28766694 DOI: 10.1111/ane.12799] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Musicogenic reflex seizures (MRS) are a rare form of seizures described in patients with temporal lobe epilepsy (TLE), mainly of unknown etiology. Epilepsy with antibodies against glutamic acid decarboxylase (GAD-ab) is a form of autoimmune epilepsy for which no specific semiology has been described. AIM OF THE STUDY To retrospectively review the incidence of MRS in the general epileptic population and in the series of patients with epilepsy and GAD-ab and to describe its clinical and paraclinical characteristics. METHODS Patients recorded between January 2010 and January 2016 in the Database of Bellvitge Hospital Epilepsy Unit were reviewed. RESULTS From a group of 1510 epileptic patients, three reported MRS (0.0019%) (two patients with epilepsy and GAD-ab and one patient with cryptogenic TLE). The incidence of MRS in patients with epilepsy and GAD-ab was 2 of 22 (9%). Both patients had a normal magnetic resonance Imaging (MRI), but FDG-PET showed medial temporal lobe hypometabolism (unilateral or bilateral) in both and also in the insula in one of them. MRS (recorded via video-EEG[electroencephalography] in one patient) arose from the right temporal lobe. CONCLUSIONS MRS may be a distinctive seizure type in patients with epilepsy and antiGADab. Determination of GAD-ab should be carried out in all cases of MRS, even those with normal structural MRI.
Collapse
Affiliation(s)
- M. Falip
- Epilepsy Unit Neurology Department Hospital Universitari de Bellvitge Hospitalet de Llobregat Spain
| | - L. Rodriguez‐Bel
- IDI (Image Diagnosis Institute) PET Division Hospital de Bellvitge Hospitalet de Llobregat Spain
| | - S. Castañer
- IDI (Image Diagnosis Institute) MRI Division Hospital de Bellvitge Hospitalet de Llobregat Spain
| | - J. Miro
- Epilepsy Unit Neurology Department Hospital Universitari de Bellvitge Hospitalet de Llobregat Spain
| | - S. Jaraba
- Epilepsy Unit Neurology Department Hospital Universitari de Bellvitge Hospitalet de Llobregat Spain
| | - J. Mora
- Nuclear Medicine Hospital de Bellvitge Hospitalet de Llobregat Spain
| | - J. Bas
- Immunology Department Hospital Universitari de Bellvitge Hospitalet de Llobregat Spain
| | - M. Carreño
- Epilepsy Unit Neurology Department Hospital Clinic I Provincial de Barcelona Barcelona Spain
| |
Collapse
|
17
|
Abstract
Reflex epilepsies (REs) are identified as epileptic seizures that are consistently induced by identifiable and objective-specific triggers, which may be an afferent stimulus or by the patient's own activity. RE may have different subtypes depending on the stimulus characteristic. There are significant clinical and electrophysiologic differences between different RE types. Visual stimuli-sensitive or photosensitive epilepsies constitute a large proportion of the RE and are mainly related to genetic causes. Reflex epilepsies may present with focal or generalized seizures due to specific triggers, and sometimes seizures may occur spontaneously. The stimuli can be external (light flashes, hot water), internal (emotion, thinking), or both and should be distinguished from triggering precipitants, which most epileptic patients could report such as emotional stress, sleep deprivation, alcohol, and menstrual cycle. Different genetic and acquired factors may play a role in etiology of RE. This review will provide a current overview of the triggering factors and management of reflex seizures.
Collapse
Affiliation(s)
| | - Çiğdem Özkara
- Department of Neurology and Clinical Neurophysiology, Cerrahpasa Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| |
Collapse
|
18
|
Nagahama Y, Kovach CK, Ciliberto M, Joshi C, Rhone AE, Vesole A, Gander PE, Nourski KV, Oya H, Howard MA, Kawasaki H, Dlouhy BJ. Localization of musicogenic epilepsy to Heschl's gyrus and superior temporal plane: case report. J Neurosurg 2017; 129:157-164. [PMID: 28946181 DOI: 10.3171/2017.3.jns162559] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Musicogenic epilepsy (ME) is an extremely rare form of the disorder that is provoked by listening to or playing music, and it has been localized to the temporal lobe. The number of reported cases of ME in which intracranial electroencephalography (iEEG) has been used for seizure focus localization is extremely small, especially with coverage of the superior temporal plane (STP) and specifically, Heschl's gyrus (HG). The authors describe the case of a 17-year-old boy with a history of medically intractable ME who underwent iEEG monitoring that involved significant frontotemporal coverage as well as coverage of the STP with an HG depth electrode anteriorly and a planum temporale depth electrode posteriorly. Five seizures occurred during the monitoring period, and a seizure onset zone was localized to HG and the STP. The patient subsequently underwent right temporal neocortical resection, involving the STP and including HG, with preservation of the mesial temporal structures. The patient remains seizure free 1 year postoperatively. To the authors' knowledge, this is the first reported case of ME in which the seizure focus has been localized to HG and the STP with iEEG monitoring. The authors review the literature on iEEG findings in ME, explain their approach to HG depth electrode placement, and discuss the utility of STP depth electrodes in temporal lobe epilepsy.
Collapse
Affiliation(s)
| | | | | | | | | | - Adam Vesole
- 3Carver College of Medicine, University of Iowa Hospitals and Clinics; and
| | | | | | | | - Matthew A Howard
- Departments of1Neurosurgery and.,4Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Brian J Dlouhy
- Departments of1Neurosurgery and.,4Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa
| |
Collapse
|
19
|
Wolf P. Reflex epileptic mechanisms in humans: Lessons about natural ictogenesis. Epilepsy Behav 2017; 71:118-123. [PMID: 25958226 DOI: 10.1016/j.yebeh.2015.01.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 11/17/2022]
Abstract
The definition of reflex epileptic seizures is that specific seizure types can be triggered by certain sensory or cognitive stimuli. Simple triggers are sensory (most often visual, more rarely tactile or proprioceptive; simple audiogenic triggers in humans are practically nonexistent) and act within seconds, whereas complex triggers like praxis, reading and talking, and music are mostly cognitive and work within minutes. The constant relation between a qualitatively, often even quantitatively, well-defined stimulus and a specific epileptic response provides unique possibilities to investigate seizure generation in natural human epilepsies. For several reflex epileptic mechanisms (REMs), this has been done. Reflex epileptic mechanisms have been reported less often in focal lesional epilepsies than in idiopathic "generalized" epilepsies (IGEs) which are primarily genetically determined. The key syndrome of IGE is juvenile myoclonic epilepsy (JME), where more than half of the patients present reflex epileptic traits (photosensitivity, eye closure sensitivity, praxis induction, and language-induced orofacial reflex myocloni). Findings with multimodal investigations of cerebral function concur to indicate that ictogenic mechanisms in IGEs largely (ab)use preexisting functional anatomic networks (CNS subsystems) normally serving highly complex physiological functions (e.g., deliberate complex actions and linguistic communication) which supports the concept of system epilepsy. Whereas REMs in IGEs, thus, are primarily function-related, in focal epilepsies, they are primarily localization-related. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".
Collapse
Affiliation(s)
- Peter Wolf
- Danish Epilepsy Centre Filadelfia, Kolonivej 2, DK-4293 Dianalund, Denmark; Department of Clinical Medicine, Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
| |
Collapse
|
20
|
Garcia-Cairasco N, Umeoka EHL, Cortes de Oliveira JA. The Wistar Audiogenic Rat (WAR) strain and its contributions to epileptology and related comorbidities: History and perspectives. Epilepsy Behav 2017; 71:250-273. [PMID: 28506440 DOI: 10.1016/j.yebeh.2017.04.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the context of modeling epilepsy and neuropsychiatric comorbidities, we review the Wistar Audiogenic Rat (WAR), first introduced to the neuroscience international community more than 25years ago. The WAR strain is a genetically selected reflex model susceptible to audiogenic seizures (AS), acutely mimicking brainstem-dependent tonic-clonic seizures and chronically (by audiogenic kindling), temporal lobe epilepsy (TLE). Seminal neuroethological, electrophysiological, cellular, and molecular protocols support the WAR strain as a suitable and reliable animal model to study the complexity and emergent functions typical of epileptogenic networks. Furthermore, since epilepsy comorbidities have emerged as a hot topic in epilepsy research, we discuss the use of WARs in fields such as neuropsychiatry, memory and learning, neuroplasticity, neuroendocrinology, and cardio-respiratory autonomic regulation. Last, but not least, we propose that this strain be used in "omics" studies, as well as with the most advanced molecular and computational modeling techniques. Collectively, pioneering and recent findings reinforce the complexity associated with WAR alterations, consequent to the combination of their genetically-dependent background and seizure profile. To add to previous studies, we are currently developing more powerful behavioral, EEG, and molecular methods, combined with computational neuroscience/network modeling tools, to further increase the WAR strain's contributions to contemporary neuroscience in addition to increasing knowledge in a wide array of neuropsychiatric and other comorbidities, given shared neural networks. During the many years that the WAR strain has been studied, a constantly expanding network of multidisciplinary collaborators has generated a growing research and knowledge network. Our current and major wish is to make the WARs available internationally to share our knowledge and to facilitate the planning and execution of multi-institutional projects, eagerly needed to contribute to paradigm shifts in epileptology. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".
Collapse
Affiliation(s)
- Norberto Garcia-Cairasco
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Brazil; Neuroscience and Behavioral Sciences Department, Ribeirão Preto School of Medicine, University of São Paulo, Brazil.
| | - Eduardo H L Umeoka
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Brazil; Neuroscience and Behavioral Sciences Department, Ribeirão Preto School of Medicine, University of São Paulo, Brazil
| | | |
Collapse
|
21
|
Muñoz LJ, Carballosa-Gautam MM, Yanowsky K, García-Atarés N, López DE. The genetic audiogenic seizure hamster from Salamanca: The GASH:Sal. Epilepsy Behav 2017; 71:181-192. [PMID: 27072920 DOI: 10.1016/j.yebeh.2016.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 03/01/2016] [Accepted: 03/04/2016] [Indexed: 12/17/2022]
Abstract
The hamster has been previously described as a paroxysmal dystonia model, but our strain is currently recognized as a model of audiogenic seizures (AGS). The original first epileptic hamster appeared spontaneously at the University of Valladolid, where it was known as the GPG:Vall line, and was transferred to the University of Salamanca where a new strain was developed, named GASH:Sal. By testing auditory brainstem responses, the GASH:Sal exhibits elevated auditory thresholds that indicate a hearing impairment. Moreover, amplified fragment length polymorphism analysis distinguished genetic differences between the susceptible GASH:Sal hamster strain and the control Syrian hamsters. The GASH:Sal constitutes an experimental model of reflex epilepsy of audiogenic origin derived from an autosomal recessive disorder. Thus, the GASH:Sal exhibits generalized tonic-clonic seizures, characterized by a short latency period after auditory stimulation, followed by wild running, a convulsive phase, and finally stupor, with origin in the brainstem. The seizure profile of the GASH:Sal is similar to those exhibited by other models of inherited AGS susceptibility, which decreases after six months of age, but the proneness across generations is maintained. The GASH:Sal can be considered a reliable model of audiogenic seizures, suitable to investigate current antiepileptic pharmaceutical treatments as well as novel therapeutic drugs. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".
Collapse
Affiliation(s)
- Luis J Muñoz
- Animal Research Service, University of Salamanca, 37007 Salamanca, Spain.
| | - Melissa M Carballosa-Gautam
- Institute for Neuroscience of Castilla y León/IBSAL, C/ Pintor Fernando Gallego, No. 1, 37007 Salamanca, Spain; The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, 1095 NW 14thTerrace, Room 2-34, Miami, FL 33136, USA
| | - Kira Yanowsky
- Institute for Neuroscience of Castilla y León/IBSAL, C/ Pintor Fernando Gallego, No. 1, 37007 Salamanca, Spain
| | - Natividad García-Atarés
- Department of Anatomy and Radiology, School of Medicine, University of Valladolid, 47007, Spain
| | - Dolores E López
- Institute for Neuroscience of Castilla y León/IBSAL, C/ Pintor Fernando Gallego, No. 1, 37007 Salamanca, Spain; Department of Cell Biology and Pathology, University of Salamanca, Spain
| |
Collapse
|
22
|
BOŞNAK MEHMET, KURT AKİFHAKAN, YAMAN SELMA. BEYNİMİZİN MÜZİK FİZYOLOJİSİ. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2017. [DOI: 10.17517/ksutfd.296621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
23
|
Musicogenic Epilepsy and Treatment of Affective Disorders: Case Report and Review of Pathogenesis. Cogn Behav Neurol 2016; 29:212-216. [PMID: 27984259 DOI: 10.1097/wnn.0000000000000109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Musicogenic epilepsy is a rare syndrome in which music triggers seizures. Affective network processing appears to play a key role in epileptogenesis. Many people with epilepsy suffer from comorbid affective disorders, the shared basis of which involves similar pathophysiologies, including deficiencies of serotonergic and noradrenergic function. Seizures and mood disorders may thus have reciprocal effects on one another, particularly in emotionally precipitated syndromes such as musicogenic epilepsy. I report a man with long-standing depression and anxiety who developed focal epilepsy that evolved into musicogenic seizures. His case suggests a pathophysiologic basis for this shared phenomenon.
Collapse
|
24
|
|
25
|
Erdener ŞE, Tezer FI, Oğuz KK, Kamışlı Ö, Ergün EL, Söylemezoğlu F, Saygi S. Reflex Seizures Triggered by Exposure to Characters With Numerical Value: A Case With Right Temporal Cortical Dysplasia. Clin EEG Neurosci 2016; 47:220-3. [PMID: 25994764 DOI: 10.1177/1550059415585195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/07/2015] [Indexed: 11/17/2022]
Abstract
Reflex seizures can be triggered by a variety of stimuli. We present a case with drug-resistant complex partial seizures originating in right temporal lobe triggered extensively by visual, auditory, and mental exposure to multidigit numbers. The patient was investigated in video-EEG monitoring unit and seizures were triggered by numerical stimuli. Scalp EEG findings suggested a right temporal focus but ictal semiological findings suspicious for an extratemporal area necessitated the invasive EEG study. A right anterior temporal seizure focus was established with invasive monitoring and cortical stimulation studies. Magnetic resonance imaging showed a cortical dysplasia in right anterior temporal lobe and ictal single-photon emission computed tomography confirmed the epileptogenic focus, leading to a right temporal lobectomy and amygdalohippocampectomy and a pathological diagnosis of focal cortical dysplasia type Ia. The patient is seizure-free at the end of the second postoperative year despite repeated exposures to numbers. To our knowledge, this is the first report of seizures triggered by numbers. It is also of particular importance as the reflex seizures are associated with a cortical lesion and it may suggest involvement of right anterior temporal lobe in numerical processing.
Collapse
Affiliation(s)
- Şefik Evren Erdener
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - F Irsel Tezer
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kader K Oğuz
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Özden Kamışlı
- Department of Neurology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Eser Lay Ergün
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Figen Söylemezoğlu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serap Saygi
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
26
|
Neurology of ecstatic religious and similar experiences: Ecstatic, orgasmic, and musicogenic seizures. Stendhal syndrome and autoscopic phenomena. Neurologia 2016; 34:55-61. [PMID: 27340019 DOI: 10.1016/j.nrl.2016.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/11/2016] [Accepted: 04/20/2016] [Indexed: 11/23/2022] Open
Abstract
All human experiences, including mystical and religious ones, are the result of brain functional activity. Thanks to the study of cases of ecstatic epilepsy with structural (MRI) and functional neuroimaging (fMRI, PET, SPECT) and neurophysiological technologies (recording and stimulation with intracranial electrodes), we now have a better knowledge of certain mental states which involve pleasant and affective symptoms and clarity of mind. These ecstatic experiences are thought to be caused by the activation of the anterior insular cortex and some neuronal networks (basically related to mirror neurons and salience) participating in introspection, social cognition, memory, and emotional processes. Thus, neuroscience could explain in a retrospective way some facts surrounding the situations of such relevant figures as Paul the Apostle, Teresa de Cepeda y Ahumada, and Dostoevsky, whose origin was previously considered paranormal or supernatural. Ecstatic epilepsy shares symptoms and mechanisms with orgasmic epilepsy (spontaneous orgasms in the course of epileptic seizures), musicogenic epilepsy (epileptic seizures triggered by listening to a certain musical piece), and also with Stendhal syndrome (neuropsychiatric disturbances caused when an individual is exposed to large amounts of art) and some autoscopic phenomena (out-of-body experiences that occasionally take place in imminent death situations). In all these events, there are pleasant and affective symptoms which have a great impact on patients.
Collapse
|
27
|
Lin K, Guaranha M, Wolf P. Reflex epileptic mechanisms in ictogenesis and therapeutic consequences. Expert Rev Neurother 2016; 16:573-85. [PMID: 26999567 DOI: 10.1586/14737175.2016.1169174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent studies of reflex epileptic mechanisms in human epilepsy using advanced methods of neurophysiology and functional neuroimaging have contributed much to elucidate pathophysiological processes of seizure generation. Whereas in lesional focal epilepsies reflex mechanisms usually relate directly to the anatomical focus, in system epilepsies they have helped to define which functional anatomical systems serving physiological function are recruited by the ictogenic mechanisms. Reflex epileptic seizures can often be prevented by avoidance or modification of triggers or by prophylactic benzodiazepine administration. Surgical options apply to focal cases. According to restricted experiences with pharmacotherapy, without controlled studies and little information on new AEDs, reflex seizures in system epilepsies appear to respond best to valproic acid and in focal epilepsies, to carbamazepine.
Collapse
Affiliation(s)
- Katia Lin
- a Serviço de Neurologia, Departamento de Clínica Médica , Hospital Universitário, Universidade Federal de Santa Catarina (UFSC) , Florianópolis , SC , Brazil
| | - Mirian Guaranha
- b Hospital São Paulo , Universidade Federal de São Paulo , São Paulo , Brazil
| | - Peter Wolf
- a Serviço de Neurologia, Departamento de Clínica Médica , Hospital Universitário, Universidade Federal de Santa Catarina (UFSC) , Florianópolis , SC , Brazil.,c Danish Epilepsy Centre , Dianalund , Denmark
| |
Collapse
|
28
|
Klamer S, Rona S, Elshahabi A, Lerche H, Braun C, Honegger J, Erb M, Focke NK. Multimodal effective connectivity analysis reveals seizure focus and propagation in musicogenic epilepsy. Neuroimage 2015; 113:70-7. [PMID: 25797835 DOI: 10.1016/j.neuroimage.2015.03.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/08/2015] [Accepted: 03/12/2015] [Indexed: 11/20/2022] Open
Abstract
Dynamic causal modeling (DCM) is a method to non-invasively assess effective connectivity between brain regions. 'Musicogenic epilepsy' is a rare reflex epilepsy syndrome in which seizures can be elicited by musical stimuli and thus represents a unique possibility to investigate complex human brain networks and test connectivity analysis tools. We investigated effective connectivity in a case of musicogenic epilepsy using DCM for fMRI, high-density (hd-) EEG and MEG and validated results with intracranial EEG recordings. A patient with musicogenic seizures was examined using hd-EEG/fMRI and simultaneous '256-channel hd-EEG'/'whole head MEG' to characterize the epileptogenic focus and propagation effects using source analysis techniques and DCM. Results were validated with invasive EEG recordings. We recorded one seizure with hd-EEG/fMRI and four auras with hd-EEG/MEG. During the seizures, increases of activity could be observed in the right mesial temporal region as well as bilateral mesial frontal regions. Effective connectivity analysis of fMRI and hd-EEG/MEG indicated that right mesial temporal neuronal activity drives changes in the frontal areas consistently in all three modalities, which was confirmed by the results of invasive EEG recordings. Seizures thus seem to originate in the right mesial temporal lobe and propagate to mesial frontal regions. Using DCM for fMRI, hd-EEG and MEG we were able to correctly localize focus and propagation of epileptic activity and thereby characterize the underlying epileptic network in a patient with musicogenic epilepsy. The concordance between all three functional modalities validated by invasive monitoring is noteworthy, both for epileptic activity spread as well as for effective connectivity analysis in general.
Collapse
Affiliation(s)
- Silke Klamer
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany; MEG Center, University of Tuebingen, Tuebingen, Germany.
| | - Sabine Rona
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | - Adham Elshahabi
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany; MEG Center, University of Tuebingen, Tuebingen, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany; Werner Reichardt Centre for Integrative Neuroscience, Tuebingen, Germany
| | - Christoph Braun
- MEG Center, University of Tuebingen, Tuebingen, Germany; Werner Reichardt Centre for Integrative Neuroscience, Tuebingen, Germany; CIMeC, Center for Mind/Brain Sciences, University of Trento, Trento, Italy
| | - Jürgen Honegger
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | - Michael Erb
- Department of Biomedical Magnetic Resonance, University of Tuebingen, Tuebingen, Germany
| | - Niels K Focke
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany; Werner Reichardt Centre for Integrative Neuroscience, Tuebingen, Germany
| |
Collapse
|
29
|
Alvarez-Rodriguez J. Hypersynchronic Mental Automatisms: An Innovative Psychiatric Hypothesis Reaffirming Its Validity for Fifteen Years. Health (London) 2015. [DOI: 10.4236/health.2015.71006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
30
|
|
31
|
Abstract
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.
Collapse
Affiliation(s)
- John Stern
- Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| |
Collapse
|
32
|
Irmen F, Wehner T, Lemieux L. Do reflex seizures and spontaneous seizures form a continuum? - triggering factors and possible common mechanisms. Seizure 2014; 25:72-9. [PMID: 25645641 DOI: 10.1016/j.seizure.2014.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/06/2014] [Accepted: 12/14/2014] [Indexed: 11/26/2022] Open
Abstract
Recent changes in the understanding and classification of reflex seizures have fuelled a debate on triggering mechanisms of seizures and their conceptual organization. Previous studies and patient reports have listed extrinsic and intrinsic triggers, albeit their multifactorial and dynamic nature is poorly understood. This paper aims to review literature on extrinsic and intrinsic seizure triggers and to discuss common mechanisms among them. Among self-reported seizure triggers, emotional stress is most frequently named. Reflex seizures are typically associated with extrinsic sensory triggers; however, intrinsic cognitive or proprioceptive triggers have also been assessed. The identification of a trigger underlying a seizure may be more difficult if it is intrinsic and complex, and if triggering mechanisms are multifactorial. Therefore, since observability of triggers varies and triggers are also found in non-reflex seizures, the present concept of reflex seizures may be questioned. We suggest the possibility of a conceptual continuum between reflex and spontaneous seizures rather than a dichotomy and discuss evidence to the notion that to some extent most seizures might be triggered.
Collapse
Affiliation(s)
- Friederike Irmen
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Tim Wehner
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom.
| |
Collapse
|
33
|
Italiano D, Ferlazzo E, Gasparini S, Spina E, Mondello S, Labate A, Gambardella A, Aguglia U. Generalized versus partial reflex seizures: a review. Seizure 2014; 23:512-20. [PMID: 24766826 DOI: 10.1016/j.seizure.2014.03.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/24/2014] [Indexed: 11/30/2022] Open
Abstract
In this review we assess our currently available knowledge about reflex seizures with special emphasis on the difference between "generalized" reflex seizures induced by visual stimuli, thinking, praxis and language tasks, and "focal" seizures induced by startle, eating, music, hot water, somatosensory stimuli and orgasm. We discuss in particular evidence from animal, clinical, neurophysiological and neuroimaging studies supporting the concept that "generalized" reflex seizures, usually occurring in the setting of IGE, should be considered as focal seizures with quick secondary generalization. We also review recent advances in genetic and therapeutic approach of reflex seizures.
Collapse
Affiliation(s)
- Domenico Italiano
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy.
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | - Angelo Labate
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; National Research Council, Piano Lago di Mangone, Cosenza, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| |
Collapse
|
34
|
Illingworth JL, Ring H. Conceptual distinctions between reflex and nonreflex precipitated seizures in the epilepsies: a systematic review of definitions employed in the research literature. Epilepsia 2013; 54:2036-47. [PMID: 24032405 DOI: 10.1111/epi.12340] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 11/29/2022]
Abstract
Seizure precipitation is a defining characteristic of reflex seizures and epilepsies, but seizure precipitants are also commonly reported for patients with epilepsies not considered to be reflex in nature. This raises the questions of exactly how reflex and nonreflex epilepsies with seizure precipitants are defined, and how these concepts are differentiated from one another in current practice. In this systematic literature review, definitions of reflex seizures, reflex epilepsies, and precipitation in a nonreflex context were extracted from published primary research papers. Content analysis was applied to these definitions to identify their main features, allowing comparisons to be made between definitions of the different concepts. Results indicated that there was little consistency within definitions of a given term, and that although some differences in definition content were found between terms, it was evident that clear defining characteristics to differentiate them from one another were lacking. These findings are discussed in the context of current debates regarding classification of the reflex epilepsies and the extent to which the distinction between reflex and nonreflex epilepsies is a meaningful one. Suggestions are made for how clarity might be increased in ongoing research in this area.
Collapse
|
35
|
|
36
|
Abstract
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.
Collapse
|
37
|
Striano S, Coppola A, del Gaudio L, Striano P. Reflex seizures and reflex epilepsies: old models for understanding mechanisms of epileptogenesis. Epilepsy Res 2012; 100:1-11. [PMID: 22361339 DOI: 10.1016/j.eplepsyres.2012.01.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 01/22/2012] [Accepted: 01/27/2012] [Indexed: 11/28/2022]
Abstract
Reflex seizures and epilepsies represent an ancient human model to understand basic mechanisms of epilepsy. The increase of light stimulation makes this issue extremely actual and interesting. In addition, a lot of observations show the frequent occurrence of provoked seizures in malformations of cortical development and in recently defined conditions such as familial or sporadic lateral temporal epilepsy. Advances in morphological and functional neuroimaging techniques, and the possibility of their fusion with EEG (e.g., fMRI-EEG co-registration) offer a unique non-invasive opportunity to investigate cortical areas and brain networks involved in cerebral functions and in epileptic discharges.
Collapse
Affiliation(s)
- Salvatore Striano
- Epilepsy Centre, Department of Neurological Sciences, Federico II University, Napoli, Italy.
| | | | | | | |
Collapse
|
38
|
Affiliation(s)
- Peter Wolf
- Danish Epilepsy Center Filadelfia, Dianalund, Denmark.
| | | |
Collapse
|