Opinion – Luciano Melo: The music that takes the plummet, musicogenic epilepsy

V., a 19-year-old girl, for the first time, felt a sublime ecstasy when listening to music. A little earlier, she was leafing through the menu at a restaurant table, with her parents. There was a song performed unpretentiously, fulfilling its background role. Everything predictable and peaceful, even a piano solo that captures the girl’s attention. The sound was amplified in her ears, the rest around her became blurred, her mind was tuning in harmony only the musical notes. It didn’t last long, V. felt a strange taste, more a horrible smell. These senses, meaningless, also brief, were replaced by stings perceived to the left in her body.

Afterwards, she had the terrible impression that she was losing her life, when she finally fell unconscious, her body in spasms. He woke up minutes later, slowly. Still not understanding what had happened, she gave in to an overwhelming need to cry. She cried a good cry, she thought the tears restored her. The recovered girl was taken to a nearby hospital. There, she was told that her blood sugar had dropped too low, a risk faced by diabetics like V. The young woman was fasting and had injected insulin at the usual time.

Months later, V was resting in a square when he felt for the second time, that intense contentment. It happened when he was listening to a piano, played by speakers, belonging to some unknown person. The woman, fearing she had a sugar crash, ran to a nearby bakery, she needed to eat something so she wouldn’t get sick again, she thought. Swallowing a croissant, he prided himself on his successful strategy, not feeling the abnormalities progress.

Safe, she returned to the square, only this time, as soon as she heard the sound of the piano again, she fell unconscious. Hours later, she got an appointment with her doctor, who referred her to a neurologist. Her problem wasn’t caused by sugar variations.

In a hospital, electrodes were glued to her head. The neurologist monitored the brain’s electrical activity as she listened to various music, but only the sound of the piano changed the facts. Listening to the instrument, the girl turned her eyes to the left, with a blank look, then in an expression of panic. Her lips moved strangely, as if she insisted on tasting something bad-tasting. Then V. struggled with convulsions. Electricity recordings revealed that the seizure had started in the right temporal lobe. Anatomists, in the late 19th century, already knew that lesions in this part of the brain made some people unable to differentiate music from disorganized noises. The right side of the brain specializes in analyzing rhythm, tones, and other melodic components, while the left side handles semantic analysis. V. was diagnosed with musicogenic reflex epilepsy.

Reflex epilepsy means epileptic seizures provoked by some stimulus. Anyone can affect susceptibles, such as light, cold water, and even the simple act of chewing. Very few people convulse listening to music, V. only, to the sound of the piano. A specific handful of neurons in V’s right temporal lobe exaggeratedly responded to the sound of a single musical instrument. Then the abnormal activity spread throughout the brain, as seismic activity spreads across the Earth from an epicenter.

The condition of V., his vulnerability so select, is intriguing. However, there is one thing that makes it all the more curious. V. epilepsy is an autoimmune disease. There is an autoantibody frequently produced by people with musicogenic epilepsy and by young diabetics, anti-GAD. An autoantibody is an antibody that attacks body structures, instead of fighting an external element, which would be, for example, a bacterium or a toxin.

We still do not know the real relationship between anti-GAD and musicogenic epilepsy and diabetes. Perhaps, this is just a marker of an immune dysfunction, still mysterious. Our ignorance is frightening, yet we can make important considerations. The high specificity of an autoimmune disease, capable of provoking a behavior as peculiar as that of V, proves that antibodies can influence our behavior. Perhaps, one day we will be able to manipulate these properties in our favor, activating or deactivating brain areas, with the intention of fighting depression, chronic pain, addictions and epilepsy, for example.

REFERENCES

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3. Gillinder L, Britton J. Autoimmune-Associated Seizures. Continu Minneap Minn. 2022 Apr 1;28(2):363–98.
4. Morano A, Orlando B, Fanella M, Cerulli Irelli E, Colonnese C, Quarato P, et al. Musicogenic epilepsy in paraneoplastic limbic encephalitis: a video-EEG case report. Epileptic Disord Int Epilepsy J Videotape. 2021 Oct 1;23(5):754–9.