A Novel Case of Musical Hallucinations

Megan Brooks

August 26, 2013

Two neurologists from Illinois report a unique case of musical hallucinations that they say raises "intriguing" questions regarding memory, forgetting, and access to lost memories.

The 60-year-old woman, with a history of bilateral sensory-neural hearing loss and tinnitus, reported hearing music one night while trying to fall asleep. She said it was like a radio playing at the back of her head. Within 4 months, she was hearing music all the time. She would hear 1 song over and over for 3 weeks, than another song.

What's novel about this case, say Danilo Vitorovic, MD, and José Biller, MD, from the Department of Neurology, Stritch School of Medicine, Loyola University, Maywood, Illinois, is that the songs she heard were popular tunes that her husband recognized when she sang or hummed them, but she herself could not identify them.

"She could actually hum the tunes and retrieve the lyrics to an extent of nonrecognizable songs," Dr. Biller noted in an interview with Medscape Medical News. "That to us was unique."

Dr. Biller and his colleague present the case and review the literature on musical hallucinations in the August 8 issue of Frontiers in Neurology.

Lost, or Not Accessible?

The authors believe this is the first known case of a patient hallucinating music that was familiar to people around her, but not to herself. It's possible the songs were buried in her memory but she could not access them except when she was hallucinating. This prompts the question: Is forgotten information lost, or just not accessible? Only further research will tell.

Musical hallucinations, the experience of hearing music when none is played, are thought to be rare, "although it is conceivable that someone may not want to report that they are hearing music," Dr. Biller said. "Even our patient was kind of doubtful and thought, 'am I going insane?'"

According to cases that have been reported in the literature, musical hallucinations typically occur in women (70%) and in older people (>60 years), although there are reports of patients in their 20s.

Potential etiologic or predisposing factors include hearing impairment, psychiatric disorders, focal brain lesions, generalized brain atrophy, epilepsy, and intoxications. Hearing impairment is the most common predisposing condition but is not by itself sufficient to cause hallucinations, Dr. Biller and Dr. Vitorovic note in their article.

Dr. Biller also noted that some medications have been associated with musical hallucinations. These include opioids (tramadol, oxycodone, morphine), benzodiazepines, and tricyclic antidepressants.

Musical hallucinations usually involve tunes that are well known to the patient, unlike the current case. For example, Dr. Biller and Dr. Vitorovic cite a paper published in 2005 in which 26 of 30 consecutive patients with musical hallucinations seen over a 15-year period heard familiar tunes, mostly religious hymns (Int J Geriatr Psychiatry. 2005;20:658-660).

There are also reports of musical hallucinations representing novel musical motifs, such as an 83-year-old musician who was able to notate her hallucinations — these motifs were not part of any known musical piece.

"It's been reported that the famous composer Robert Schumann created music based on his musical hallucinations, the classic example is the Violin Concerto in D Minor," Dr. Biller said.

Musical hallucinations are thought to represent abnormal activity in the auditory associative cortices. They can be intrusive and unpleasant. There is no curative treatment at present.

Dr. Biller and Dr. Vitorovic say current treatments are based on removing potential inciting factors (discontinuing hearing aids, treating underlying psychiatric disorder, stopping medications that may be the cause, treating epileptic seizures, or removing focal lesions if possible) or starting a medication reported to improve symptoms, such as certain antipsychotics (olanzapine and quetiapine), antidepressants (fluvoxamine and clomipramine), antiepileptic medications (carbamazepine and valproate), and donepezil.

For Dr. Biller's patient, who was "quite bothered" by her musical hallucinations, treatment with carbamazepine led to some improvement, he said.

Front Neurol. Published online August 8, 2013. Abstract

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