There is also a need to standardize the assessment of treatment responses, and document long-term follow up.Īuditory Charles Bonnet syndrome auditory hallucination brain lesion epilepsy intoxication/pharmacology psychiatric disorder. There is a need to establish the natural course of musical hallucinations, their response to non-pharmacological treatments, and their effects on the patient's quality of life. Treatments for musical hallucinations tend to yield favorable results when they target the main etiological factor of these phenomena. When intoxication/pharmacology is the main etiological factor, it is important to stop or switch the causative substance or medication. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. The limited use of acetylcholinesterase inhibitors has looked promising. Pharmacological treatment methods can also be successful, with antidepressants being possibly more helpful than antiepileptics (which are still better than antipsychotics). In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g., more acoustic stimulation) are frequently helpful. Distinct etiological groups appear to respond differently to treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. When hallucinations are bearable, patients can be reassured without any other treatment. Musical hallucinations can disappear without intervention. Auditory or musical hallucinations have been associated with different neuropsychological disorders (25) such as schizophrenia (26), depression (27), epilepsy (28), hearing loss (25,29), traumatic. We analyzed the treatment results in relation to the etiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion, and other pathology, epilepsy or intoxication/pharmacology. To review the effects of published treatment methods for musical hallucinations.Ī literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare. We, therefore, conclude that musical hallucinations in epilepsy open a window to understanding these phenomena in a variety of conditions.Īntiepileptic Auditory hallucination EEG MEG Musical hallucinosis Pharmacotherapy.Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. An analysis of phenomenological characteristics, pharmacological triggers, and treatment effects suggests wider ramifications for understanding musical hallucinations. To account for the underlying mechanism we propose a Bayesian model involving top-down and bottom-up prediction errors within the auditory network that incorporates findings from EEG and MEG studies. Musical hallucinations (MHs) are rare and most often described in patients with hearing loss, female sex, older age, and various brain pathologies, including epilepsy. The case descriptions suggest that musical hallucinations in epilepsy can be conceptualised as lying on a continuum with other auditory hallucinations, including verbal auditory hallucinations, and-notably-tinnitus. Based on the phenomenological descriptions and neurophysiological data, we distinguish four subgroups of epilepsy-related musical hallucination, comprising auras/ictal, inter-ictal and post-ictal phenomena, and phenomena related to brain stimulation. We also describe six of our own patients. Our search yielded 191 articles, which together describe 983 unique patients, with 24 detailed descriptions of musical hallucinations related to epilepsy. We, therefore, reviewed the literature, and assessed all descriptions of musical hallucinations attributed to epileptic activity. Their relation with epilepsy was first described over a century ago, but never systematically explored. In summary, musical hallucinations can be separated into five categories according to their cause: hypoacusis, psychiatric disorders, brain lesions, epilepsy. Musical hallucinations are poorly understood phenomena.
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