Dados do Trabalho

Título

Musicogenic Epilepsy: a rare case of music-evoked seizures

Apresentação do caso

A 36-year-old female patient referred for a 60-hour Video-encephalographic Monitoring (VEEG) in 2014. A car accident in 2002 with traumatic brain injury, without knowledge of brain injuries at the time, was reported in her medical record. After 3 years of the event, she developed aware seizures preceded by a felling of fear and déjà vu, autonomic aura (epigastric sensation) and visual aura (light flashes) associated with behavioral arrest and oromandibular automatisms. She was on carbamazepine, lamotrigine and clobazam; and previously received phenobarbital and topiramate among antiepileptic drugs (AED). These episodes were triggered by watching certain movies and listening to certain songs, being the largest association with Sarah McLachlan’s song "Angel" from the "City of Angels" soundtrack. Interictal EEG demonstrated a symmetric and organized background activity with occasional epileptiform discharges in the right anterior temporal region (F8). During VEEG, a gradual reduction of AED was performed associated with visual and sound stimulation of music and film, with 2 seizures recorded. The initial seconds of the ictal EEG was obscured by muscular artifacts, later evolving with rhythmic activity (theta) in the right hemisphere with predominance in the anterior temporal region. In the subsequent seconds, the ictal activity propagated bilaterally, maintaining predominance in the right cerebral hemisphere. The postictal exhibited a diffuse attenuation of the background activity. After the seizures, immobility of the right arm was noticed. Neurophysiologic evaluation was complemented with Brain MRI, without any abnormality; and interictal and ictal SPECT, which suggested left lateralization.

Discussão

musicogenic epilepsy is a rare type of reflex epilepsy in which seizures are triggered by musical stimuli, usually with emotional value for the patient. Considering that the processing of music and language are functions of the right and left temporal lobes, respectively, functional neuroimaging studies show predominance on the right in most cases, however, there are descriptions of involvement of the left temporal lobe.

Comentários finais

the case described a VEEG having lateralization in the right temporal region according to the literature, but the ictal and interictal SPECT did not lateralize.