Musical hallucinations and their relation with epilepsy

Abstract

Musical hallucinations are poorly understood phenomena. Their relation with epilepsy was first described over a century ago, but never systematically explored. We, therefore, reviewed the literature, and assessed all descriptions of musical hallucinations attributed to epileptic activity. Our search yielded 191 articles, which together describe 983 unique patients, with 24 detailed descriptions of musical hallucinations related to epilepsy. We also describe six of our own patients. Based on the phenomenological descriptions and neurophysiological data, we distinguish four subgroups of epilepsy-related musical hallucination, comprising auras/ictal, inter-ictal and post-ictal phenomena, and phenomena related to brain stimulation. The case descriptions suggest that musical hallucinations in epilepsy can be conceptualised as lying on a continuum with other auditory hallucinations, including verbal auditory hallucinations, and—notably—tinnitus. To account for the underlying mechanism we propose a Bayesian model involving top-down and bottom-up prediction errors within the auditory network that incorporates findings from EEG and MEG studies. An analysis of phenomenological characteristics, pharmacological triggers, and treatment effects suggests wider ramifications for understanding musical hallucinations. We, therefore, conclude that musical hallucinations in epilepsy open a window to understanding these phenomena in a variety of conditions.

New Insights Into the Anatomy, Connectivity and Clinical Implications of the Middle Longitudinal Fasciculus

“…Case #2 displayed a low-grade astrocytoma that involved the pSTG, PT, and aTTG on the left side. Also this patient experienced auditory hallucinations ("intermittent whistling sound inside my head"), confirming the common origin for this phenomenon within the STG (Coebergh, 1990;Lennox et al, 2000;Braun et al, 2003;Bernardini et al, 2017). The main white matter pathways involved in the tumor area were the pMdLF and the short fibers of the AF (Figures 10, 11b, 12B).…”

“…In case # 1, the tumor was located at the aSTG and TP on the right side (Figures 9, 11a). Musical hallucinations are commonly found to originate from temporal regions in both the primary and secondary auditory cortices of either of hemispheres in patients with schizophrenic disorders or brain lesions (Coebergh, 1990;Lennox et al, 2000;Braun et al, 2003;Bernardini et al, 2017). In our patient, the original type of hallucinations (melodies) together with the anatomical location and the possible white matter connectivity underlying the symptoms confirm the role of non-dominant hemisphere in this type of phenomena (Critchley, 1977;Clynes, 1982;Berrios, 1990;Lennox et al, 2000;Braun et al, 2003;Stewart and Brennan, 2005).…”

Transient Musical Hallucinations in a Young Adult Male Associated with Alcohol Withdrawal

“…An alternative is that MH arises from “parasitic” musical memories which become inappropriately activated [5]. A Bayesian-based model, based on neurophysiological and phenomenological observations, proposes that musical hallucinations arise from top-down and bottom-up prediction errors [16]. Finally, it has been hypothesised that MH arise from “cerebral irritation” triggering activation of musical memories stored in neural networks, likely involving the auditory association cortex.…”

Magnetoencephalography for epileptic focus localization based on Tucker decomposition with ripple window

“…MEG, non‐invasive and real‐time monitoring of brain function, 6,7 has been commonly used in the diagnosis of neurological diseases 8 . Here are some reasons: First, the spatial resolution and temporal resolution are high 9 .…”