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Reflex epilepsy : a musicogenic epilepsy : case report
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Introdução:Epilepsia musicogénica é um exemplo raro de epilepsia reflexa, onde as convulsões são provocadas por música. Apesar de alguns autores já terem tentado explicar quais são os mecanismos desta epilepsia, a sua patogénese exacta continua a ser um mistério até aos dias de hoje.
Objectivo:Este artigo abordará um caso de epilepsia musicogénica e reverá a literatura
existente sobre epilepsia reflexa, dando especial ênfase à epilepsia musicogénica e possíveis triggers musicogénicos.
Método:O caso clinico descrito foi estudado usando entrevista clínica directa e exame
objectivo, com subsequente revisão retrospectiva do processo clínico. Para realizar a revisão da literatura existente, foram consultadas bases de dados, usando os termos ‘‘reflex epilepsy’’ (epilepsia reflexa), ‘‘reflex seizure’’ (convulsão reflexa), ‘‘musicogenic epilepsy’’ (epilepsia musicogénica), „audiogenic epilepsy“ (epilepsia audiogénica) e ‘‘treatment reflex epilepsy“ (tratamento da epilepsia reflexa).
Resultados: O nosso artigo relata o caso de uma paciente dextra de 71 anos. As convulsões começaram quando a paciente tinha 62 anos e eram desencadeadas quase exclusivamente pela audição de música. As convulsões eram caracterizadas por alterações da consciência e automatismos bilaterais dos braços e mãos, com duração entre alguns segundos até um minuto. Estes episódios eram seguidos por um periodo de cerca de trinta minutos, onde a paciente tinha uma sensação de fadiga e ainda não era responsiva a estímulos externos. As convulsões começaram aproximadamente 14 anos após a remoção cirúrgica de um meningioma com topografia paramediana occipital esquerda. A ressonância magnética mostrou uma área de encefalomalácia cortico-subcortical paramedial occipital à esquerda. O EEG ictal mostrou actividade epileptiforme no lobo temporal esquerdo com início ictal parieto-temporal esquerdo. Actualmente, a paciente é medicada com Clobazam, Topiramato, Carbamazepina e Lamotrigina e evita todos os tipos de música, mantendo no entanto uma frequência média de 2 convulsões por mês.
Conclusão: A nossa paciente apresenta uma epilepsia musicogénica causada exclusivamente por música, 14 anos após a a excisão de um meningioma. O EEG ictal revelou um início da crise parieto-temporal à esquerda, enquanto a ressonância magnética demonstrou uma área de encefalomalácia occipital. Fazendo medicação com anti-epilépticos e evitando ouvir música, a paciente ainda mantém uma frequência de 2 convulsões por mês. Depois de rever a literatura sobre convulsões reflexas e musicogénicas, nós concluimos que a lesão cerebral apresentada pela nossa doente difere significativamente da maioria dos casos já descritos, resultando contudo, no mesmo tipode epilepsia. A epilepsia musicogénica é , de facto uma síndrome muito heterogénea com diferentes resultados em pacientes diferentes. Ainda não foram descritos muitos casos até hoje e é necessário invertigar mais e melhor a patogénese desta epilipsia, para, ultima e optimamente, conseguir dar a estes pacientes o tratamento mais adequado e mais eficaz possível.
Introdution: Musicogenic Epilepsy (ME) is rare example of reflex epilepsy, in which seizures are provoked by music. Although some authors already tried to explain its mechanism or which brain areas are involved in its process, ME’s exact pathophysiology remains a mystery until now. Objective: This article reports a case of musicogenic epilepsy and reviews the literature concerning reflex epilepsies (RE) with special emphasis on musicogenic epilepsy and possible musicogenic triggers. Methods: The clinical case was studied by direct clinical interview and clinical examination and restrospective review of the clinical data sheets. For the literature review, database were searched using the terms ‘‘reflex epilepsy’’, ‘‘reflex seizure’’, ‘‘musicogenic epilepsy’’, „audiogenic epilepsy“and ‘‘treatment reflex epilepsy“. Results: Our patient is a 71-year-old right-handed woman who experienced seizures at the age of 62 almost exclusively caused by listening to music. The seizures are chareterized by impairment of consciousness and automatisms involving both hands and arms, bilaterally, which lasted from seconds to one minute. These episodes were followed by a period of about thirty minutes during which the patient felt fatigued and was still not responsive. The seizure’s onset started approximately 14 years after a left paramedian occipital meningioma excision. MRI showed a left occipital paramedical area of corticosubcortical encephalomalacia. The ictal EEG showed epileptiform activity on the temporal left lobe with left temporoparietal onset. Nowadays, the patient takes Clobazam, Topiramate, Carbamazepine and Lamotrigine and avoids all kind of music, maintaining an average 2 seizures per month. Conclusion: Our patient presents a ME caused exclusively by music, 14 years after a meningiom excision. Ictal EEG revealed a left temporoparietal onset, while MRI demonstrated an occipital encephalomalacia. With AE medication, and avoiding music, our patient maintains an average of 2 seizures per month. After reviewing literature on reflex and musicogenic seizures, we conclude that our patient demonstrated a brain lesion that differs significantly from the ones already reported, having the same resulting epilepsy. Musicogenic epilepsy is indeed a heterogeneous syndrome with different studies results in different patients. Not many cases have been reported as of yet and further investigation is definitely warranted to elucidate its pathogenesis and, ultimately, to provide ME’s patients the most adequate and efficient treatment.
Introdution: Musicogenic Epilepsy (ME) is rare example of reflex epilepsy, in which seizures are provoked by music. Although some authors already tried to explain its mechanism or which brain areas are involved in its process, ME’s exact pathophysiology remains a mystery until now. Objective: This article reports a case of musicogenic epilepsy and reviews the literature concerning reflex epilepsies (RE) with special emphasis on musicogenic epilepsy and possible musicogenic triggers. Methods: The clinical case was studied by direct clinical interview and clinical examination and restrospective review of the clinical data sheets. For the literature review, database were searched using the terms ‘‘reflex epilepsy’’, ‘‘reflex seizure’’, ‘‘musicogenic epilepsy’’, „audiogenic epilepsy“and ‘‘treatment reflex epilepsy“. Results: Our patient is a 71-year-old right-handed woman who experienced seizures at the age of 62 almost exclusively caused by listening to music. The seizures are chareterized by impairment of consciousness and automatisms involving both hands and arms, bilaterally, which lasted from seconds to one minute. These episodes were followed by a period of about thirty minutes during which the patient felt fatigued and was still not responsive. The seizure’s onset started approximately 14 years after a left paramedian occipital meningioma excision. MRI showed a left occipital paramedical area of corticosubcortical encephalomalacia. The ictal EEG showed epileptiform activity on the temporal left lobe with left temporoparietal onset. Nowadays, the patient takes Clobazam, Topiramate, Carbamazepine and Lamotrigine and avoids all kind of music, maintaining an average 2 seizures per month. Conclusion: Our patient presents a ME caused exclusively by music, 14 years after a meningiom excision. Ictal EEG revealed a left temporoparietal onset, while MRI demonstrated an occipital encephalomalacia. With AE medication, and avoiding music, our patient maintains an average of 2 seizures per month. After reviewing literature on reflex and musicogenic seizures, we conclude that our patient demonstrated a brain lesion that differs significantly from the ones already reported, having the same resulting epilepsy. Musicogenic epilepsy is indeed a heterogeneous syndrome with different studies results in different patients. Not many cases have been reported as of yet and further investigation is definitely warranted to elucidate its pathogenesis and, ultimately, to provide ME’s patients the most adequate and efficient treatment.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 20
Palavras-chave
Epilepsia reflexa Música Neurologia