Musicogenic epilepsy in paraneoplastic limbic encephalitis: a video-EEG case report

Area of Science:

• Neurology
• Epileptology
• Neuroimmunology

Background:

• Musicogenic epilepsy (ME) is a rare reflex epilepsy where music provokes seizures.
• Emotional response to music is often implicated in ME seizure generation.
• Autoimmune encephalitis is an emerging potential cause of ME, particularly with anti-GAD65 antibodies.

Purpose of the Study:

• To describe a case of drug-resistant temporal lobe epilepsy with musicogenic seizures.
• To investigate the potential role of autoimmune encephalitis in ME.
• To explore non-emotional, cognitive triggers in music-induced seizures.

Main Methods:

• Case report of a 25-year-old male with a history of limbic encephalitis and drug-resistant epilepsy.
• Utilized 24-h ambulatory EEG and prolonged video-EEG monitoring.
• Analyzed seizure activity during music exposure, including a novel hard-rock song.

Main Results:

• The patient experienced music-induced seizures, confirmed via EEG.
• A right temporal seizure occurred while listening to music, characterized by déjà-vu, piloerection, and gustatory hallucinations.
• The seizure occurred without apparent emotional distress, suggesting a cognitive trigger.

Conclusions:

• Autoimmune encephalitis should be considered in the differential diagnosis of ME, even in seronegative cases.
• This case suggests that cognitive processing of music, not just emotional response, can trigger seizures in ME.
• Further research is needed to understand the mechanisms of music-induced seizures in autoimmune encephalitis.