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• W2073214046 abstract "The brain basis of musical experience has attracted much recent interest (1), and specific deficits of music processing and emotional responses to music have been described (2, 3). Increased musical interest and responsiveness (“musicophilia”) have been reported rarely in the setting of focal brain lesions (4) and degenerative disease (5). Here we describe a patient in whom striking musicophilia developed after treatment for partial epilepsy involving the right temporal lobe. A 65-year-old right-handed woman was first seen with a 7-year history of episodes of altered awareness. During the episodes, which occurred up to several times per week, she became uncommunicative and would stare blankly ahead. She recovered within a few minutes and had no recollection of the episodes. Between the episodes, she complained of poor memory for everyday events, and she had poor recollection of personal life events, such as holidays, during the preceding 5 to 10 years. These memory difficulties were not temporally related to the episodes of altered awareness. The patient was born in Bangkok and moved to the United Kingdom at age 19 years. Birth and early development were normal, with no history of childhood seizures. She had mumps at age 6 years, which left her deaf in the right ear, but hearing remained normal in the left ear. At the time of presentation, the neurologic and general physical examinations were normal. Neuropsychometry revealed a selective deficit in face-recognition memory and mild inefficiency on tests of attention; no other cognitive deficits were found. Routine EEG revealed focal epileptiform discharges in both temporal regions, more prominently on the right, and 24-h scalp EEG telemetry recorded six partial seizures associated with ictal discharge involving right frontotemporal regions. Clinical manifestations were limited to facial automatisms (blinking of eyelids and eye closure). Volumetric structural brain magnetic resonance imaging at 1.5 Tesla was normal. A diagnosis of partial epilepsy of temporal lobe origin was made, and lamotrigine (LTG) was commenced (maintenance dose, 75 mg daily). No further clinical seizures appeared. A repeated interictal EEG showed mild nonspecific slow activity over the right temporal region, but no epileptiform abnormalities. The patient's memory for daily events improved, although she had persistent retrograde memory loss for fixed time periods. Neuropsychometry on treatment showed improvement of face-recognition memory and persistent mild attentional inefficiency. After the commencement of LTG, the patient and her husband reported that a craving for music had developed. Before the introduction of LTG, she had always been indifferent to music, never listening to music for pleasure or attending concerts. This was in contrast to her husband and daughter, who played the piano and violin, respectively, to competent amateur standard. The patient had had little exposure to music as a child, apart from attending mass at convent school, and no musical training. She was unmoved by the traditional Thai music she had heard at family and public events in Bangkok and by classical and popular genres of Western music after she moved to the United Kingdom. Indeed, she continued to avoid music where possible, and actively disliked certain musical timbres (for example, she would shut the door to avoid hearing her husband playing piano music, and found choral singing “irritating”). Within several weeks of starting LTG, a profound change was noted in her appreciation of music. She sought out musical programmes on the radio and television, listened to classical music stations on the radio for many hours each day, and demanded to attend concerts. Her husband described how she had sat “transfixed” throughout La Traviata and became annoyed when other audience members talked during the performance. She now described listening to classical music as an extremely pleasant and emotion-charged experience. She did not sing or whistle, and no other changes were found in her behavior or personality. No evidence of thought disorder, hallucinations, or disturbed mood was seen. The patient had always been skilled in needlework, and this interest was unchanged; no other new hobbies or interests appeared. This case illustrates the development of a craving for music as an isolated behavioral change after the introduction of treatment for epilepsy. In our patient, partial epilepsy involved the right temporal lobe, a brain region that plays a critical role in processing timbre and other musical properties (6). Bilateral mesial temporal lobe structures including the amygdala are implicated in strong emotional responses to many phenomena, including music (2, 7). Our patient's “music-seeking” behavior is likely to have been driven by the intensely pleasurable emotional response that she derived from listening to music. It is not clear, however, why anticonvulsant treatment was associated with the development of this altered emotional response to music, which was at odds with the patient's lifelong aversion. The brain networks that mediate the cognitive and emotional processing of music are complex (1), and we can only speculate as to the mechanism of musicophilia in the present case. It is unlikely that this was a manifestation of a more general alteration or disinhibition of emotional responses, because no suggestion existed of a similar alteration in other behavioral domains. In particular, no evidence was seen of an underlying neurodegenerative process such as frontotemporal lobar degeneration, which may be associated with the development of new musical and other artistic interests (5). Precise localization of the seizure disturbance was not possible on clinical or electrophysiologic grounds in the present case, and we cannot exclude the involvement of other brain regions in the left temporal or frontal lobes. However, we postulate a specific interaction between right temporal lobe circuits involved in musical processing and those involved in emotional responses to music. It is possible that the emotional valence of musical stimuli might be altered because of a functional reorganization of neocortico-limbic interactions secondary to long-standing temporal lobe seizures. Complex behavioral changes associated with altered emotional tone are a well-recognized consequence of temporo-limbic damage and may be specific for particular categories of stimuli (8, 9). Treatment of seizures might restore information flow through reorganized temporal lobe networks, allowing the expression of a novel emotional response to music. This process might bear some similarity to the controversial phenomenon of “forced normalization,” whereby behavioral changes in the context of improved seizure control may arise from electrophysiologic and neurochemical alterations involving limbic circuitry (10). It is further possible that such an effect might be facilitated by particular anticonvulsants such as LTG, although the present case does not resolve this issue. This case does, however, demonstrate the potential for strikingly specific “positive” behavioral changes in the context of improved seizure control. Acknowledgment: We thank the patient and her husband for their participation and Professor M.N. Rossor for supervising her initial clinical care. We are grateful to members of the Neuropsychology Department of the National Hospital for Neurology and Neurosurgery for performing neuropsychological assessments. J.D.R. is supported by a Wellcome Trust Research Training Fellowship. J.D.W. is supported by EC contract LSHM-CT-2003-503330 (The APOPIS Consortium)." @default.
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• W2073214046 date "2006-05-01" @default.
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• W2073214046 title "Craving for Music after Treatment for Partial Epilepsy" @default.
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• W2073214046 doi "https://doi.org/10.1111/j.1528-1167.2006.00565.x" @default.
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