When music, an instrument or a voice triggers epileptic seizures

This is the story of a 48-year-old woman referred to neurology for episodes of abnormal movements occurring over the past year after listening to romantic music. The most recent episode occurred while she was listening to this type of music: she first cried, then felt a sensation of heat in her right upper limb. The convulsions generally last 45 seconds and are followed by no memory of the seizure (postictal amnesia). These episodes are accompanied by oral automatisms, namely involuntary, repetitive, and stereotyped movements of the mouth (chewing, swallowing, lip smacking).

For the past year, she has been treated with lamotrigine, an antiepileptic drug. She has no history of medical or neurological illness: no meningitis, no febrile seizures, no head trauma. She has never smoked or used drugs.

An electroencephalogram (EEG) performed while listening to music revealed electrical abnormalities in the left anterior temporal lobe. A brain scan (single-photon emission computed tomography, or SPECT), performed between seizures, showed increased blood flow (hyperperfusion) in this same region. Blood tests revealed the presence of anti-GAD65 antibodies, directed against the enzyme glutamate decarboxylase 65, which is essential for the synthesis of GABA (gamma-aminobutyric acid), the main inhibitory neurotransmitter in the central nervous system.

This patient, whose case was published in April 2025 by neurologists at the Tehran University of Medical Sciences (Iran) in the journal Clinical Case Reports , suffers from autoimmune encephalitis, a disease in which the immune system attacks specific brain cells. The presence of antibodies directed against GAD65 in the blood is a biological marker of this pathology.

The patient received a corticosteroid (methylprednisolone) for five days. In the absence of improvement, intravenous immunoglobulin treatment was prescribed for five days. The clinical and laboratory improvement allowed her to return home, with a treatment combining lamotrigine, clobazam (an anxiolytic with anticonvulsant properties), and azathioprine (an immunosuppressant).

This clinical case therefore concerns a rare form of musicogenic epilepsy in a middle-aged woman, with positive anti-GAD65 antibodies, suggesting an autoimmune component. Some studies have reported that patients developed type 1 diabetes, another autoimmune pathology, after the onset of epilepsy.

Musicogenic epilepsy is an extremely rare form of epilepsy, with an estimated prevalence of one case per ten million people. It is most often a reflex epilepsy, i.e., triggered by sensory stimuli, in this case, music. Seizures are most often focal, originating in a specific area of ​​the brain, with altered consciousness. They are often accompanied by automatisms (involuntary and repetitive gestures). Generalized tonic-clonic seizures are rare.

Other neurological causes have sometimes been identified: focal cortical dysplasia type I (corresponding to brain lesions of developmental origin), astrocytoma (infiltrating brain tumor), demyelinating lesions (damage to the white matter), or even autoimmune encephalitis with anti-GAD65 antibodies, as in the case presented.

Musicogenic epilepsy generally begins late, with an average age of onset around 28 years. It is triggered by specific pieces of music. It differs from audiogenic epilepsy, which is triggered by sudden, nonspecific noises without musical content and appears earlier, often in childhood.

Although both are induced by sounds, these two forms of epilepsy rely on very distinct mechanisms and triggers: musicogenic seizures generally occur with a latency of a few minutes, whereas audiogenic seizures are triggered immediately after sound exposure.

Musicogenic epilepsy was formally identified in 1937 in the journal Brain by British neurologist MacDonald Critchley. A nursing assistant in his department told him that music triggered her seizures. Critchley then noticed that Tchaikovsky's Waltz of the Flowers, performed by the Berlin State Opera, caused her to experience increasing anxiety followed by convulsive movements. As the music played, the patient appeared increasingly oppressed.

Another patient described by Critchley speaks of a diffuse malaise: her voice becomes unsteady, everything seems to move away, then she loses consciousness and convulses. Her husband describes a scream of terror, a distorted face, one leg raised, all in a state of unconsciousness. The trigger was Johann Strauss's Arabian Nights. Even when the music doesn't trigger a seizure, she is visibly upset while the music is playing, and relieved once it stops.

A careful clinician, Critchley then documented eleven patients with similar seizures and expanded his analysis to include other reported cases. Some were musicians, others not. A few responded only to very specific sounds or instruments: one patient only triggered seizures when he heard the low notes of a brass instrument. A radio operator on an ocean liner, he was assigned to a ship without a band because every musical performance caused him to convulse. Other patients responded to specific melodies or songs.

It is quite possible that descriptions of music-induced epileptic seizures were reported before the 20th century. Indeed, in 1884, at the congress of the Psychiatric Association in St. Petersburg, a case of musicogenic epilepsy was presented: it concerned the music critic Nikonov, whose seizures were triggered by listening to unfamiliar music. His case was later published in an article stating that this famous critic had his first seizure during a performance of Meyerbeer's opera Le Prophète at the Imperial Theatre. "During the ice skating ballet in the third act, he became trembling, sweating profusely, and his left eye began to tremble."

It was not until 1947 that this type of seizure was correlated with abnormalities observed on the electroencephalogram (EEG). Most patients have epileptic foci located in the temporal lobe. Between 1884 and 2007, 110 cases of musicogenic epilepsy were recorded.

Published in the journal Epilepsia in 1997, a Swiss study analyzed 83 patients with musicogenic epilepsy, taking into account musical triggers. It emerged that only 14 of them (17%) had seizures triggered exclusively by music and never experienced them when they were not listening to music.

The crisis may be preceded by an aura, in other words, warning symptoms. Depending on the case, the following have been reported: nausea, an unpleasant sensation in the abdomen, dizziness, palpitations, a strange feeling in the head, a visual phenomenon, the perception of sounds that have become distant, a rhythm heard mentally followed by the perception of a musical tune accompanied by a feeling of fear, a looped auditory perception, or even the perception of an indescribable smell lasting 5 to 10 seconds.

The Chinese poet Kung Tzu Chen had already mentioned this type of crisis in 1847: "Since my distant childhood, I have always been prey to bewilderment as soon as I heard the flute of a street vendor. I feel bad when I hear this sound at sunset, without knowing the reason."

Shakespeare may even have been aware of such phenomena when he wrote in The Merchant of Venice (Act IV, Scene 1): "There are some people who do not like to see a pig yawn, — others who go mad looking at a cat, — others who, when the bagpipe sings in their face, — cannot hold their urine."

In 1991, an American neurologist described in the New England Journal of Medicine the case of a woman who experienced epileptic seizures upon hearing the voice of Mary Hart, co-host of the hit television show Entertainment Tonight. Exposure to this easily recognizable voice, broadcast daily at a fixed time, was enough to trigger a seizure. A video-EEG recording showed that the partial seizures originated in the right temporal region and systematically occurred while watching the recorded program.

Remarkably, the seizures were only triggered by the presenter's voice; neither the images, the music of the program, nor other female voices or similar broadcasts provoked any reaction. During the two years of follow-up, the patient no longer experienced seizures, provided she avoided this program and continued antiepileptic treatment prescribed for absence seizures.

The case has inspired several works of fiction, including an episode of the NBC sitcom Seinfeld , in which Kramer's character convulses upon hearing Mary Hart's voice on television.

As early as 1969, two American neurologists reported in the journal Neurology the case of a 52-year-old woman whose seizures were triggered by the voices of three radio hosts. Simply hearing them was enough to induce epileptic activity in the left temporal lobe. Sometimes, announcements broadcast in stores or other public places also trigger partial seizures.

Epileptic seizures can be precipitated by a musical style (classical, lyrical, religious, military, jazz, musical comedy), a particular instrument (piano, violin, organ), a tone (happy, sad, sentimental music), or even a composer (Wagner, Beethoven).

Some cases are unusual. A 35-year-old American woman, for example, had almost all of her seizures triggered by the sound of a vacuum cleaner—and one of them occurred while her husband was watching The Lord of the Rings: The Fellowship of the Ring in the next room. For neurologists who published this case in 2004 in Neurology , the vacuum cleaner noise exhibited variations in frequency and timbre that recalled the tonal complexity of certain music. During a video-EEG recording at the hospital, the patient was asked to vacuum. After about a minute, she turned it off, sat down, and then had a seizure with oral automatisms (involuntary mouth movements). The EEG then detected an electrical discharge located in the left temporal region.

Another case, reported in 2015 in Handbook of Clinical Neurology , also attracts attention. It concerns a 46-year-old woman whose seizures are triggered by singing. Over time, other triggers appear: electronic music, heavy metal, flute, or even music described as "scratchy" because of high-pitched sounds. A singular fact: for nearly ten years, classical music has a protective effect. It can even interrupt a seizure. To avoid exposure to other music in public places, the patient wears headphones that continuously play classical music. But this protection eventually disappears. Classical music, in turn, becomes a trigger. At this stage, all types of music can provoke a seizure, but some more than others. Madonna's music proves to be the most "effective."

Affective components appear to play an important role in some cases. In 1997, Japanese neuropsychiatrists reported observing a woman who had her first seizure on a tour bus after hearing the song The Song of Sailing Round the Lake Biwa . She was 42 years old at the time. This song, which celebrates the scenery of Lake Biwa, Japan's largest freshwater lake, enjoyed great popularity between 1925 and 1940. Shortly after its creation, tragedy struck: a crew of high school students perished in a shipwreck on the lake. This accident inspired the composition of The Elegy of the Lake Biwa , a song whose melody closely resembles that of the first song.

In 1964, when this woman was 67 years old, she felt sick every time she heard The Song of Sailing Round the Lake Biwa on television, convulsing six or seven times. An electroencephalogram definitively established that the patient suffered from musicogenic epilepsy. The patient enjoyed music, especially Japanese, folk, and popular songs. However, she did not like The Song of Sailing Round the Lake Biwa . Without remembering the lyrics, she found the melody heartbreaking.

In 2001, Turkish neurologists described a case of a 32-year-old woman who experienced her first music-induced seizure during a wedding reception. Although she was unable to specify the type or content of the music being played at the time, she later acknowledged that particularly sad songs triggered her seizures.

In 2014, a study using functional MRI, which visualizes brain activity in real time, was conducted on patients whose epileptic seizures were linked to emotions triggered by music. Published in the journal Epileptic Disorders , this research tends to show that it is not so much the music that triggers the seizures, but rather the way the brain processes emotions. Indeed, changes in brain activity appear in areas involved in cognitive processes and the regulation of emotions.

Melodies that trigger epileptic seizures vary greatly, often related to emotional context. Surprising cases have been reported, such as a 55-year-old woman who convulsed while listening to La Marseillaise , and a 43-year-old man who had a seizure while listening to music from The X-Files .

A particularly fascinating case was described by London neurologists in 1962 in the journal Brain . It concerned a 62-year-old British civil servant whose seizures were triggered only by the ringing of church bells. Until the age of 56, he had no symptoms.

It all began when he lost consciousness three times while listening to the radio at exactly 8:59 p.m. He was unaware of the cause of his fainting spells, but later realized that they occurred at the exact moment the BBC's famous Bow Bells chime sounded.

In 1955, he was transferred to an office where, every day at 4:27 p.m., a recording of church bells announced the end of the workday. For the first nine months, no seizures occurred for the simple reason that the loudspeaker in his office was broken. Once it was repaired, the seizures resumed: the patient became pale, mumbled, seemed distracted, and made remarks that had no real connection to the ongoing conversation.

But that's not all. During a seaside vacation in 1958 and 1960, he suffered a seizure after hearing bells in the street. He began to tremble for two to three minutes, became incoherent, and continued to walk.

The most serious episode occurred in May 1960: sitting in a car, fortunately stopped, he lost consciousness after hearing the famous bells on the radio, suffered a generalized seizure (grand mal) and fractured his right arm. During these episodes, the patient never bit his tongue and never lost urine.

Having understood what triggered his seizures, he would rush to turn off the radio as soon as he heard the BBC chimes. This technique worked for him, as he no longer had seizures without the sound of church bells.

In the vast majority (80% of cases), music-triggered seizures originate in the temporal lobe , and in about 60% of cases on the right side. More rarely, epileptogenic discharges appear independently in both temporal lobes. The epilepsy can then spread rapidly to the opposite temporal lobe, or even to other areas such as the Heschl's gyrus, the insula , and spread to the anterior frontal regions .

Sometimes treatment involves resection of the temporal lobe epileptogenic zone. Several cases of successful surgical interventions have been reported in the medical literature, offering hope to some patients for whom music-related seizures have become disabling and resistant to antiepileptic treatment.

Finally, let's mention a very unusual case, especially since it involves an infant. In 2003, Taiwanese neurologists reported in Pediatric Neurology the story of a six-month-old boy with seizures localized to the right side of his body, sometimes generalized. Surprisingly, his seizures were often triggered by loud music, particularly that of the Beatles.

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