Thursday, September 19, 2013

Loyola neurologists report unique form of musical hallucinations

Case raises intriguing questions about memory and forgetting

The case of a patient hallucinating music -- songs that were familiar to people around her, but that she herself did not recognize -- raises “intriguing questions regarding memory, forgetting and access to lost memories.

One night when she was trying to fall asleep, a 60-year-old woman suddenly began hearing music, as if a radio were playing at the back of her head.

The songs were popular tunes her husband recognized when she sang or hummed them. But she herself could not identify them.

This is the first known case of a patient hallucinating music that was familiar to people around her, but that she herself did not recognize, according to Dr. Danilo Vitorovic and Dr. José Biller of Loyola University Medical Center in Maywood, Ill. The neurologists describe the unique case in the journal Frontiers in Neurology.

The case raises “intriguing questions regarding memory, forgetting and access to lost memories,” the authors write.

Musical hallucinations are a form of auditory hallucinations, in which patients hear songs, instrumental music or tunes, even though no such music is actually playing. Most patients realize they are hallucinating, and find the music intrusive and occasionally unpleasant. There is no cure.

Musical hallucinations usually occur in older people. Several conditions are possible causes or predisposing factors, including hearing impairment, brain damage, epilepsy, intoxications and psychiatric disorders such as depression, schizophrenia and obsessive-compulsive disorder. Hearing impairment is the most common predisposing condition, but is not by itself sufficient to cause hallucinations.

Vitorovic and Biller describe a hearing-impaired patient who initially hallucinated music when she was trying to fall asleep. Within four months, she was hearing music all the time. For example, she would hear one song over and over for three weeks, then another song would begin playing. The volume never changed, and she was able to hear and follow conversations while hallucinating the music.

The patient was treated with carbamazepine, an anti-seizure drug, and experienced some improvement in her symptoms.

The unique feature of the patient was her ability to hum parts of some tunes and recall bits of lyrics from some songs that she did not even recognize. This raises the possibility that the songs were buried in her memory, but she could not access them except when she was hallucinating.

“Further research is necessary on the mechanisms of forgetfulness,” Vitorovic and Biller write. “In other words, is forgotten information lost, or just not accessible?"

Vitorovic is a former chief neurology resident and Biller is a professor and chair in the Department of Neurology of Loyola University Chicago Stritch School of Medicine.

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH), on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, Loyola Outpatient Center, and Loyola Oral Health Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 254-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 22 states from coast to coast with 93 hospitals, and 120 continuing care locations — including home care, hospice, PACE and senior living facilities — that provide nearly 2.5 million visits annually.