Musical hallucinations after left temporal lobectomy.
BACKGROUND
Musical hallucinations (MHs) are rare and most often described in patients with hearing loss, female sex, older age, and various brain pathologies, including epilepsy.


METHODS
We describe a unique case in which, after successful left temporal lobectomy for refractory epilepsy and subsequent ototoxic therapies, a 49-year-old man experienced the onset of songs replaying constantly in his mind for days to weeks. He had intractable partial epilepsy since age 26. Presurgical neurodiagnostic evaluations revealed a left temporal focus, left hippocampal magnetic resonance imaging abnormalities, bilateral language representation, and cognitive deficits lateralized to the left hemisphere. He underwent a partial left temporal lobectomy but required repeated antibiotic courses for postoperation bone flap infections, resulting in tinnitus. Surgery led to near seizure-freedom, plus improved cognitive and emotional function. Pathology revealed focal cortical dysplasia. Six months postsurgery, during antibiotic treatment, he began to hear songs replaying in his head, which increased in frequency over ensuing years.


CONCLUSIONS
We report, to our knowledge, the first case of MHs associated with temporal lobectomy for epilepsy. This patient had multiple risk factors for these unwanted musical experiences, including epilepsy, mild neuropsychiatric dysfunction, and tinnitus plus hearing loss. Possible mechanisms for MHs are discussed.
Williams
Vanessa G
VG
Department of Psychiatry, Warren Alpert Medical School of Brown University, RI, USA.
Tremont
Geoffrey
G
Blum
Andrew S
AS
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000633:toxicity; D001284:Atrophy; D004292:Dominance, Cerebral / Q000502:physiology; D004359:Drug Therapy, Combination; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D004830:Epilepsy, Tonic-Clonic / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D005500:Follow-Up Studies; D006212:Hallucinations / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D008875:Middle Aged; D009146:Music; D009483:Neuropsychological Tests; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D013530:Surgical Wound Infection / Q000188:drug therapy; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014012:Tinnitus / Q000139:chemically induced / Q000175:diagnosis / Q000523:psychology; D014640:Vancomycin / Q000008:administration & dosage / Q000633:toxicity
D000900:Anti-Bacterial Agents; D014640:Vancomycin