Epilepsia musicogénica - epileptogénese e atualização da sua abordagem

Abstract

Musicogenic epilepsy (ME) is a rare form of reflex epilepsy in which seizures are triggered by exposure to musical stimuli, in particular those with highly emotional content. Despite rare and still very unknown, this disease can be very limiting and easily underdiagnosed. It is therefore important to increase clinicians' knowledge about ME, enabling a better management of these patients. The objectives of this critical review of the literature is to systematize what is known about musicogenic epilepsy, highlighting the epileptogenic mechanisms and the updates in clinical management. The included articles were selected through the Pubmed database with the query "("Musicogenic" [Mesh]) AND "Epilepsy" [ Mesh])". The estimated prevalence of ME is 1:1.000.000, with a slight female predominance. The mean age of onset is at 28 years old (range: 2-67 years). The role and characteristics of auditory stimuli as triggers for seizures are variable and highly individualized, ranging from simple tones to complex music, and from loud, non-musical sounds to stimuli that are low in volume. The reported cases vary widely regarding the degree of musical training of the patients, occurring in professional musicians as well as in patients with no musical background at all. Seizures' onset zone is mostly located in the temporal lobe, with right-sided predominance. However, some concomitant emotional processing areas are also involved in ME, such as limbic structures, the nucleus accumbens, and the orbitofrontal and prefrontal cortex. The pathophysiology of ME has similarities with comorbid affective disorders, such as depression and anxiety disorders, supporting the involvement of affective networks in the development of ME. Recently there are reports of musicogenic reflex seizures in patients with antiGAD encephalitis. Therefore, all patients with ME should be screened for this pathology, since an earlier diagnosis will result in a more effective treatment and a better prognosis. The treatment of musicogenic epilepsy includes some non-pharmacological approaches, and antiepileptic drugs in most cases, rarely culminating in surgery. In spite of being a rare disease, ME should be easily diagnosed and treated in order to reduce the repercussions in patients' life.