Cerebral areas involved in music perception: studying musicogenic epilepsy.

Functional cerebral areas involved in listening to emotionally charged music are wider than those activated by neutral music. Based on the pathophysiology of musicogenic epilepsy, a rare form of complex reflex epilepsy in which seizures are triggered by music, we can infer the functional organization of the brain's processing of music. We studied a 36-year-old, right-handed male amateur musician, who has had weekly epileptic partial seizures every time he listened to or played music with a strong emotional charge since the age of 24 years. The patient underwent prolonged video-polygraphic recording which documented three right temporal seizures preceded for several seconds by an increase in heart rate and blood pressure, all triggered by listening to music with an emotional content. During functional neuroimaging (fMRI) he listened to both "neutral" and "emotionally charged" music. The “neutral music” activated only a small eloquent area in the right temporal lobe (acoustic area), whereas an “emotionally charged melody" activated diffuse eloquent areas on the fronto-temporo-occipital lobes of the right hemisphere before seizure onset. Numerous studies have demonstrated the predominant involvement of right hemisphere structures in networks involved in processing musical information. Most cases of musicogenic epilepsy showed the dominant role of the right temporal lobe disclosed by functional neuroimaging and neurophysiological techniques. The triggering stimulus in our patient seems to be a strong emotional feeling induced by specific melodies, as his seizures were preceded by an increase in heart rate and blood pressure. Our results emphasize the role of the right temporal lobe in musicogenic epilepsy and show that the cerebral areas activated during the emotional status leading to seizures encompass the auditory cortex activated by neutral music.