What You Need To Know About Musicogenic Epilepsy

Sounds and music are everywhere, all around us. Music brings people together, can evoke intense emotional responses, and has the capacity to change how you view the world. It’s part of your everyday life. The music you choose to listen to, as well as the tunes, played in your favorite cafe, your local supermarket, buskers in the streets, TV shows, and concerts — music is everywhere. 

For people with epilepsy, their connection with music can be more complicated. Thinking, hearing, or playing a particular type of music can be enough to cause seizures in individuals with a form of reflex epilepsy known as musicogenic epilepsy. 

What is reflex epilepsy? 

Most seizures occur spontaneously. Reflex epilepsy refers to the group of epilepsy syndromes in which seizures are triggered or induced by a particular stimulus, affecting around 7%¹ of epilepsy patients.

Stimuli can be something simple, such as light or touch. Some stimuli can be internal, such as a particular emotion or thought process.

Other types of reflex epilepsy include hot water epilepsy and reading epilepsy. In some rare cases, triggers can be very specific and complex, like playing chess or doing mathematical sums. 

Musicogenic epilepsy is a rare form of reflex epilepsy triggered by specific stimuli. It affects around one in ten million individuals globally. It likely has an underestimated prevalence because many people don’t recognize music as the trigger, and there is a lack of understanding of the disease among health professionals. 

Some people will only have a seizure in response to a specific tune. Others have more broad triggers - they may have seizures induced by a particular genre of music or music played with a particular instrument. 

What causes musicogenic epilepsy? 

Currently, little is known about the mechanisms of musicogenic epilepsy. Musicogenic epilepsy is more common in people who are musicians or have an interest in music. Consequently, it is thought that the trigger for these seizures could be an emotional response to music rather than the music itself.

Some studies² have identified increased activity in limbic regions within the temporal lobe, the emotional processing region of the brain, during musicogenic seizures, which supports this hypothesis. Other research supporting this theory has identified that there is often a delay period between the stimulus (the music) and the seizure of up to a few minutes. 

Typical cases of reflex epilepsy involve exposure to the stimulus, directly resulting in a seizure. Again, this suggests that the emotional centers or other regions of the brain may be involved, acting as an intermediary. Some seizures can also be prevented or terminated by listening to specific types of music, adding to the complexity of this condition. 

Who is at risk? 

The average age of onset for musicogenic epilepsy is 28 years. It’s also more common in women than men.

Diagnosis

Epilepsy is diagnosed by the patient having two seizures in response to a particular trigger or having two unprovoked seizures less than 24 hours apart. Diagnosis can be challenging for musicogenic epilepsy due to the highly varying triggers between individuals and the time delay between the music stimulus and the seizure.

Generally, a diagnosis will involve your doctor taking a comprehensive history. Your doctor may also carry out an electroencephalograph (EEG), testing the electrical activity of your brain in response to different types of music. 

Treatment

The first line of treatment is generally avoidance of the music that triggers your seizures. This is a more straightforward treatment program if the musical trigger is very specific. If this avoidance is not possible, your doctor will likely prescribe you antiepileptic medication

The good news is that with effective drug treatment, around 70% of individuals can remain seizure-free. 

Carbamazepine and phenytoin³ are the two main medications prescribed. Carbamazepine does have some side effects to be aware of. However, they are pretty rare. Side effects of both of these medications are drowsiness, abdominal pain, nausea, and vomiting, motor and cognitive disturbances.

In phenytoin, side effects have been reported as more severe, making it less commonly prescribed in the USA and Europe. 

Psychotherapy or behavioral therapy⁴ is another potential treatment avenue. With this method, patients may be repeatedly exposed to similar pieces of music as a means of desensitization. 

The lowdown

Musicogenic epilepsy is complex, and we have a long way to go before we understand its exact causes and triggers and can fully optimize an ideal treatment protocol. Treatment is available, as with any form of epilepsy. With further research, we will continue to develop our understanding of this interesting yet complex condition.