An fMRI study of musicogenic epilepsy: can the emotional components of music trigger the seizures?

Musicogenic epilepsy is a rare form of epilepsy. We describe a 36-years-old right-handed man, with right temporal lobe seizures since the age of 27 years. He was an amateur musician and realized that any music with a strong emotional charge was effective in precipitating seizures, even if it was only thought out. All of his seizures were musicogenic and started about 2 min after the beginning of the appropriate music. Anastasia song “Overdue Goodbye” was especially provocative even when he was playing guitar himself. Music without emotional charge (Battisti song “La canzone del sole”, or disco music) was ineffective. The patient underwent brain MRI, neuropshycological tests and prolonged video-polygraphic recording. We performed fMRI to explore the location and extent of the eloquent areas activated during the playing of the two aforesaid songs: neutral music (Battisti song “La canzone del sole”) and epileptogenic music (Anastasia song “Overdue Goodbye”). The listening of neutral music showed activated areas in the right temporal lobe in a region corresponding to the acoustic area. The listening of epileptogenic music showed a wider spreading of this area mainly towards the posterior part of the right temporal lobe up to the posterior pole of the right hemisphere, without a concomitant epileptic attack. The thinking of neutral music produced eloquent areas in the frontal pole, bilaterally, but no temporal activation was observed. The thinking of epileptogenic music caused a wide spreading of eloquent areas in the left hemisphere, from the very anterior frontal pole to the occipital one. Bilateral frontal activation was also present. The results are discussed in terms of emotional reaction to music as the stimulus effective in triggering musicogenic seizures.