A crack in the sidewalk, a stray twig, or the leg of a chair: If Janis Hellested accidentally hits any of these with her right foot, it can trigger a seizure. The 61-year-old from Cranston, RI, says her right leg starts to tingle, twitch, and shake and then becomes paralyzed. The seizures, which last about 20 seconds, only occur if her foot hits something unexpectedly, not if she purposely taps it. She once had a seizure when her right foot bumped against another passenger's luggage while she was in line to board a cruise ship.
"It's almost as if I'm startled," says Hellested, whose seizures date back to childhood but weren't fully explained until years later when she was evaluated by a neurologist near her home and then at an epilepsy monitoring unit at Brigham & Women's Hospital in Boston. Hellested takes antiseizure medication and tries to avoid hitting her right foot. "I look at the ground when I am walking. I have to be cautious," she says. But she keeps active. "I refuse to sit home and let it control me."
Hellested's seizures fall into a category known as reflex epilepsy, in which seizures result from a specific trigger, such as flashing lights, a sudden noise, touch, or motion, a certain mode of music or song, or, in extremely rare cases, laughter. In most instances of epilepsy, more general circumstances such as stress, fatigue, alcohol, or lack of sleep can increase the likelihood of a seizure, says Elson L. So, MD, FAAN, professor of neurology at Mayo Clinic Alix College of Medicine in Rochester, MN. In people with reflex epilepsy, the trigger is extremely specific, and the seizure happens soon thereafter. "It can be a specific song by a particular person or even a specific verse of the song," says Dr. So, who is a past president of the American Epilepsy Society. For some people, the trigger is a touch or motion. "If patients are interrupted in a particular way, if they are walking along and someone steps in front of them, they may have a seizure," says Dr. So. In Japan, seizures caused by video games have been reported, he says, but they are highly unusual.
Dr. So evaluated a woman from Tennessee who began having seizures during church when she heard highly emotional hymns. She would blank out and drop her hymn book. At other times, Whitney Houston's "I Will Always Love You" triggered seizures. The woman had a history of small seizures, but having one while hearing music was a new development. She said the seizures would typically begin with a sense of dread and the feeling that someone was lurking by her side. Dr. So and his Mayo Clinic team attached electrodes to the woman's scalp to study electrical activity while she listened to different types of music. An electroencephalogram (EEG) showed that slow, emotional songs triggered seizure activity in her brain's temporal lobe, while faster tunes did not. Dr. So diagnosed the woman with musicogenic epilepsy, a type of reflex epilepsy where seizures are caused by specific music or types of music, and prescribed antiseizure medication. He says he's had another patient whose seizures were triggered by Rihanna's "Disturbia" and Pharrell Williams' "Happy."
Potential Lessons
Reflex seizures such as those that Hellested and Dr. So's patients had provide an opportunity to learn more about seizures in general, says Dr. So. In fact, patients whose seizures are caused by light or light flashes are sometimes recruited to test epilepsy drugs under development; researchers administer the medication to photosensitive patients to see if they still experience seizures when exposed to light flashes.
Scientists are still in the early stages of understanding the multitude of networks of nerve cells involved in the brain's electrical activity. For reflex epilepsy, researchers are trying to figure out how something that starts in a specific area of the brain enhances electrical activity in a larger region of the brain to start a seizure. "Tests such as functional MRI, PET, or a single-photon emission computerized tomography (SPECT) scan performed during a reflex seizure may provide insights into where a seizure begins and how it spreads," Dr. So explains.
When he and two colleagues presented their case study of the Tennessee woman with musicogenic epilepsy at the American Epilepsy Society annual meeting in 2007, they explained that when she was exposed to melancholic music in the lab for 15 minutes every hour for seven hours, she exhibited fear, rapid heartbeat, crying, confusion, lip smacking, and other behaviors during three of the seven 15-minute periods. At the same time, an EEG revealed enhanced electrical activity that began in the brain's right lobe and spread to the left. When the doctors played music of a different tempo, the seizures either didn't start or stopped.
In a 2013 issue of the Journal of Medical Case Reports, doctors described a man whose seizures were induced by laughter. While watching a funny show on TV, the 43-year-old man from Reading, PA, would start laughing, then his arms would shake. "He felt like his consciousness was being vacuumed away," the doctors wrote. The patient, who had bipolar disease and chronic headaches, had no seizures except when he was laughing at comedy shows.
EEG and video monitoring were used to study the patient in the lab and revealed heightened seizure-like activity when he was provoked into laughing. He was treated with antiseizure medication and his seizures are now under control. In the report, the doctors noted that laugh-induced seizures are different from gelastic seizures, a type of epilepsy in which uncontrollable bouts of laughter are a symptom instead of the cause.
Targeted Treatment
In yet another case of reflex epilepsy, a 24-year-old woman had seizures when listening to "Temperature," a mid-2000s hit by Sean Paul. Her doctor, Alan Ettinger, MD, FAAN, a neurologist at North Suffolk Neurology in Commack, NY, used an EEG and a PET scan to pinpoint an area in the right mesial temporal lobe of the woman's brain that was stimulated when she heard the song. She underwent surgery to remove the problematic region, and today she no longer experiences seizures, says Dr. Ettinger, who is president of the professional advisory board for EPIC Epilepsy Foundation of Long Island. Dr. Ettinger published the case in 2009 in the journal Epilepsy & Behavior.
"In musicogenic epilepsy, it is unclear which element of music is responsible for the seizure," Dr. Ettinger says. "One possibility is that music's power to trigger emotions and feelings may activate the emotion-related structures of the brain, the limbic system, which may be responsible for provoking seizures. Alternatively, it may have something to do with musical rhythms."
Music Musings
Dr. Ettinger continues to research the relationship between the brain and music, including not only how music can trigger seizures in a small subset of patients but also how it can help curb or prevent seizures in other kinds of patients. When he lectures, he provides musical demonstrations by playing along with members of his jazz band, Alpha Rhythm.
"A deeper understanding of how music moves us emotionally may someday translate into novel treatments for epilepsy and other health conditions," says Dr. Ettinger.
In the meantime, the Tennessee woman with musicogenic epilepsy takes precautions. When she and her husband watch TV, he turns down the sound during commercials. If she's put on hold during a call, she keeps the phone away from her ear.
To drown out any slow, emotional music—in restaurants, grocery stores, malls, waiting rooms, elevators, even funeral homes—that might trigger a seizure, the 76-year-old woman walks around with an iPod playing up-tempo songs in her ears. She can even sit and talk with friends while the music plays softly in her ears.
She prefers tunes from when she was a young woman. Her playlist includes "Tossin' and Turnin'" by Bobby Lewis and "Don't Be Cruel" and "All Shook Up" by Elvis—oldies but goodies that help keep her free of seizures.