Musicogenic Seizures Can Arise from Multiple Temporal Lobe Foci: Intracranial EEG Analyses of Three Patients

Abstract

Summary:Purpose: To determine the ictal-onset zone of musicogenic seizures by using intracranial EEG monitoring.Methods: Musicogenic seizures in three patients with medically intractable musicogenic epilepsy were first localized by using noninvasive methods including, in one patient, ictal magnetoencephalography (MEG) and magnetic resonance spectroscopy (MRS). The ictal-onset zones in these patients were then further localized using by intracranial EEG monitoring, and the outcomes of the two patients who underwent epilepsy surgery were determined.Results: Patient 1's musicogenic seizures localized to the right lateral temporal lobe, patient 2's originated in the right mesial temporal lobe, and patient 3's arose independently from both mesial temporal lobes. Patients 1 and 2 underwent resective epilepsy surgery and are seizure free (Engel class I).Conclusions: Musicogenic epilepsy is a heterogeneous syndrome with seizures that can arise from multiple temporal lobe foci. Patients with medically intractable musicogenic epilepsy and with unilateral ictal onset zones may be considered candidates for resective epilepsy surgery.

Multimodal effective connectivity analysis reveals seizure focus and propagation in musicogenic epilepsy

“…With our methods we were able to classify this activation in the mesial frontal lobes as clear propagation of epileptic activity. The right temporal focus as the "driving force" in our case is in accordance with several reports about patients with musicogenic epilepsy who also underwent invasive EEG monitoring and who became seizure free after resection of the thus identified focus (Tayah et al, 2006;Trevathan et al, 1999). Further, our results are in line with current literature on déjà-vu experiences in epilepsy.…”

“…the seizure-related BOLD map, and previous literature (Marrosu et al, 2009;Morocz et al, 2003;Pittau et al, 2008;Tayah et al, 2006;Trevathan et al, 1999) two regions of interest (ROI) were selected as possible seizure origins in this case: the frontal (MNI: 2 60 -14 mm) and the right mesiotemporal (MNI: 38 6 -12 mm) cluster of the fMRI activation map. To perform the effective connectivity analysis based on fMRI we computed the first principal eigenvariate of the voxel time series for each ROI and mean-corrected it using the "effects of interest" F-contrast.…”

Do reflex seizures and spontaneous seizures form a continuum? – Triggering factors and possible common mechanisms

“…Seizures that occur in response to music often involve an important emotional and memory-related feature [55,101]. Musicogenic seizures have been linked to several temporal lobe foci [56], depending on the emotional content of the melody or rhythm and the associated memory. Indeed, widespread right fronto-temporal-occipital activation resulting in a seizure was recorded only if the music was emotionally charged rather than neutral [102].…”

“…Triggering factors in reflex seizures are most commonly extrinsic sensory stimuli such as flashing lights or startling noises [49]. Other documented triggers of reflex seizures include visual [50], olfactory [51] proprioceptive [52] or somatosensory stimuli [53] as well as thinking [54], music [55,56], eating [57,58], exercise [59], reading [60,61], hot water [62][63][64][65], startle [66] and even rare triggers such as orgasms [67,68] and answering telephones [69] have recently be added to the list. Extrinsic triggers remain the most common type.…”

Seizure Semiology: An Overview of the ‘Inverse Problem’

“…Musicogenic seizures may have an acoustic aura: two types of events have been described. One arising from the laterotemporal regions (auditory cortex), the other from the mesiotemporal structures (emotional component) [16]. The delay between the auditory trigger and the seizure onset suggest that these events are due to involvement of auditory association areas, rather than being simple reflex seizures occurring from the primary auditory cortex [17].…”