Musicogenic epilepsy is a rare form of reflex epilepsy, and its association with antiglutamate decarboxylase (GAD) antibodies needs better understanding. However, patients with musicogenic epilepsy who do not respond to preventive measures or become drug resistant may benefit from immunotherapy, while select cases may also require surgery, according to a case report published in Epilepsia Open.
The International League Against Epilepsy Task Force has updated the definition of epilepsy to reflect circumstances that do not meet the required definition of 2 unprovoked seizures more than 24 hours apart. Musicogenic epilepsy, a sound-induced reflex attack, is unusually rare and affects 1 in 10 million people. Neurological diseases such as musicogenic epilepsy have been linked to antibodies against GAD.
In this case report, investigators highlighted the results of a 50-year-old woman who had been diagnosed with seizure disorder for 14 years.
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The patient, housewife and mother of 5 children, suffered from hypothyroidism and insulin-dependent diabetes mellitus. She occasionally reported an aura of rare smells and reported recurrent loss of consciousness associated with oral and left-handed automatism leading to generalized tonic-clonic seizures.
Seizures occurred 4 to 5 times a month and each episode for a few seconds and showed no daily fluctuations. The primary stimulus for these seizures was loud noises, such as certain music or songs, and never occurred spontaneously, which resulted in the patient avoiding such noises.
The patient had no central nervous system infection, febrile seizures, or significant head trauma, and did not report a family history of epilepsy. She reported that she had taken carbamazepine (400 mg every 12 hours) as a control group for the past 14 years, lamotrigine (100 mg every 12 hours) for the past 14 years, and levetiracetam (1500 mg every 12 hours) for the past 2 years . She stopped taking valproate medication because she received no benefit from the treatment.
The patient had normal blood count, kidney profile, liver profile, and thyroid function tests. The results of positron emission tomography and magnetic resonance tomography were normal. In contrast, the patient had elevated glycated hemoglobin and was positive for anti-GAD antibodies.
Investigators reported seizures from the left temporal lobe, but 2 of the seizures were found in the right temporal lobe; they used video electroencephalography and semiology to confirm that the patient had focal epilepsy. This was triggered by listening to music emerging from the left temporal lobe.
In the neuropsychological examination, the patient showed a decrease in her verbal memory, her processing and her psychomotor speed; however, her other cognitive abilities were in the normal range.
The patient was recommended to initiate intravenous immunoglobulin immunotherapy but declined and was discharged with levetiracetam (1500 mg), carbamazepine (400 mg), and lamotrigine (100 mg).
“Autoimmune testing with anti-GAD antibody testing should be performed in patients with ME. In addition, a study of immunotherapy in patients with drug-resistant epilepsy and anti-GAD antibodies can be considered, ”the researchers reported.
They concluded, “Our patient has chosen to avoid the specific triggering music and stay on anti-epileptic drugs. In the absence of the effect of immunotherapy on seizures, immunopathogenesis cannot be confirmed in this case report. “
reference
Al-Attas AA, Al Anazi RF, Swailem SK. Musicogenic Reflex Seizure with Positive Anti-Glutamate Decarboxylase Antibody: A Case Report. Epilepsy open. Published online July 4, 2021. doi: 10.1002 / epi4.12518
