Thread by @hyderabaddoctor

A man who would become unconscious after singing romantic Kishore Kumar's Songs
1. 6 months ago, a 45-year-old man visited me for evaluation of a fainting episode that occurred while he was singing for a private gathering. He was a schoolteacher and singing was his passion.

2. On the fateful day, he had uneventfully sung a few songs of other singers.
On public demand, he sang “Pal pal dil ke paas”, a popular Kishore Kumar's song. A few minutes after completing the song, he collapsed on the stage and became unconscious.

3. His pulse rate was 110 beats per minute and BP was 160/100 mmHg. He was shifted to a hospital for evaluation.
He had regained consciousness while being taken to the hospital.
ECG, Echocardiogram and Cardiologist evaluation were normal.

4a. He was referred to me to rule out neurological causes. I requested the patient to narrate the entire sequence of events. He expressed that he was feeling happy at the start of the song. As he was nearing the end of the song, extreme fear and anxiety replaced his happy mood.

4b. He had a few jerky movements in lips, face, and hands. He has no memory after that, as he had fainted soon after that.
On further enquiry, he mentioned that he had experienced similar symptoms on a few earlier occasions, while singing romantic songs originally sung by Kishore

4c. He would discontinue singing as soon as the symptoms started, after which he would recover in a few minutes. He was a Kishore Kumar fan and used to emotionally connect with the lyrics of those songs.

5.He shared a tragic life event. His wife would accompany him during performances; but he lost her two years ago. Emotional & mood changes associated with singing had magnified since her passing. These songs used to aggravate the pain of losing her, as he associated them with her

6. The symptoms pointed towards a condition called as Musicogenic #Epilepsy . In this condition, epileptic #seizures are triggered by #Music (either by listening to songs or instrumental or by #Singing).
#MedTwitter #NeuroTwitter #EpilepsyAwareness

7a. MRI brain and routine EEG done elsewhere were normal. However, EEG done while singing showed epileptiform discharges from right temporal lobe. He experienced emotions of fear and anxiety, followed by jerky movements of fingers, when epileptiform discharges started on the EEG.

7b. We asked him to discontinue singing, soon after that, EEG normalized.
He had no episodes of seizures or transient emotional disturbances at other times (when he was not singing). Therefore, I did not want to start long-term anti-epileptic drug (AED) for him.

8. Discontinuing singing was not an option as he enjoyed it. So, I asked him to take an AED an hour prior to his singing performances. With this approach, he has remained asymptomatic in the past 6 months and has continued to sing his favourite Kishore kumar’s romantic songs.

9.Take home message:
Singing or listening to #Music can trigger #Epilepsy in a small proportion of people.
Accurate identification and proper treatment can result in excellent outcome.
It is rare, but I feel it may be under-reported or under-diagnosed.
#MusicogenicEpilepsy