Auditory verbal hallucinations of epileptic origin

Area of Science:

• Neuroscience
• Neurology
• Psychiatry

Background:

• Auditory verbal hallucinations (AVHs), characterized by hearing voices, are primarily studied in schizophrenia.
• Reports of AVHs in neurological patients, particularly epilepsy, are infrequent and often lack detailed characterization.

Purpose of the Study:

• To characterize the phenomenology, neuropsychological profiles, and lesion locations of AVHs in patients with pharmacoresistant epilepsy.
• To differentiate AVHs of neurological origin from those of psychiatric origin.

Main Methods:

• A cohort of 352 epilepsy patients was screened, identifying 9 with AVHs.
• Phenomenology was assessed via semistructured interviews.
• Neuropsychological testing and multimodal neuroimaging (structural, functional, EEG) were employed.

Main Results:

• AVHs in epilepsy patients were associated with language deficits and damage to left temporal cortex language areas.
• Hallucinations typically involved a single voice, same gender/language as the patient.
• AVHs were often perceived in external space, contralateral to the brain lesion.

Conclusions:

• Neurological AVHs in epilepsy are characterized by specific lesion locations (posterior/basal language areas) and associated language deficits.
• The consistent external, contralesional perception of AVHs aids in distinguishing them from psychiatric AVHs.