SAN DIEGO — Certain musical elements within songs — especially when tied to emotional memories — may trigger a rare form of epilepsy known as musicogenic epilepsy, new research suggested 

The term musicogenic epilepsy was first coined in 1937. The condition is extremely rare, with an estimated prevalence of just 1 in 10 million. Most prior research has been limited to case reports or small studies. 

Results from the new meta-analysis showed that certain auditory triggers with an emotional association to a patient’s past experience led to seizures. In addition, the studies included in the analysis identified involvement of the right temporal lobe as the most common seizure onset zone, particularly in the hippocampus. 

The analysis also showed that epilepsy surgery led to seizure freedom in all but one of the patients whose seizures originated from the left temporal lobe. 

The researchers also presented a case from their own center, involving a male patient with musicogenic epilepsy who underwent intracranial EEG monitoring. Using music signal processing, they identified a specific song that triggered seizures and pinpointed snare drums at certain frequencies as the trigger. 

What set this research apart, said co-investigator Arun Antony, MD, of Jersey Shore University Medical Center in Neptune, New Jersey, was how songs were analyzed to figure out exactly what triggered the seizure. 

In many studies, “it’s assumed that it’s the song itself in totality that was the trigger. But we found that it was specific frequencies with a specific instrument that provoked the seizure,” Antony told Medscape Medical News.

The findings were presented on April 9 during a poster presentation at the American Academy of Neurology (AAN) 2025 annual meeting.

Melodic Triggers

Reflex seizures are those that are triggered by specific stimuli, such as flashing lights, as opposed to psychogenic seizures, which are commonly triggered by psychological factors such as stress or posttraumatic stress disorder. 

In a chapter from the 2015 Handbook of Clinical Neurology, John Stern, MD, professor and director of the Epilepsy Clinical Program in the Department of Neurology, University of California-Los Angeles, noted that musicogenic epilepsy typically begins at about age 28 and that its seizures “are associated with sounds that are in melodic or harmonic combination with complex features that make specific sound triggers for each individual.”

Reflex seizures of any type are estimated to affect only 4%-7% of individuals with epilepsy, and 80% of these are thought to be triggered by visual stimuli. 

For musicogenic epilepsy, however, “the literature is sparse, demanding more evidence on the etiopathogenesis and its associated clinical features,” the current investigators noted. 

“In the last several years, I’ve come across just a handful of patients that have had music as a trigger,” said Antony, who is also director of epilepsy services at Hackensack Meridian Health System and an associate professor in the Department of Neurology at Hackensack Meridian School of Medicine in New Jersey.

It was after assessing the patient in their case report that the team decided to conduct a review of published studies focused on the condition. 

The meta-analysis included 41 studies (total number of patients, 48; average age at onset, 26 years; 71% women) with data that could be extracted to identify music as a trigger for seizures. 

The investigators found that patients who had an emotional response, whether to the music itself or to memories it evoked, were more likely to experience a seizure. 

“Past memories triggering a seizure is not uncommon in patients with epilepsy. So this could be an emotion, or a specific thought, or a memory that was triggering here,” said Antony.

In addition, the mesial or lateral temporal lobe (within the right temporal lobe) was the most common seizure onset zone. 

“These findings were consistent with imaging studies (PET/SPECT) showing hyperfusion in the temporal lobe,” the investigators wrote.

They reported that 8 of 9 patients who underwent resection were seizure-free at 1 year, achieving an Engel Class I outcome. The remaining patient continued to experience spontaneous seizures originating from the left temporal lobe.

Snare Drums as Culprit?

The case report described a 37-year-old man who had experienced episodes of dizziness, loss of awareness, and convulsions since age 25. The investigators noted that these spells were associated with “oral automatisms.” The patient reported that three to four specific songs would reliably trigger a seizure.

During the evaluation of this patient, the researchers found an onset zone in the left hippocampus for spontaneous seizures provoked by one of the songs mentioned by the patient.

Antony said they admitted the patient with the goal of capturing a seizure to determine its point of origin. When the team played a particular song that triggered a seizure, they set out to identify the specific element within the music that caused it. 

Music signal processing was used to separate harmonic and percussive sources, and “snare drums at a frequency of 1/16th or sixteenth note” had the highest likelihood of provoking seizures in the patient. “So it wasn’t the whole of the music in this case,” Antony said. 

He added that although recording brain differences during a seizure induced by a visual trigger such as flashing lights is common, this is the first time he had observed a brain change from this type of auditory stimulation.

Of note, the patient said he had no emotional reaction to the song, though he did like it very much, Antony said. 

He noted that the patient was advised to avoid this specific type of music moving forward. The patient is also being evaluated for neuromodulation, as testing indicated that he is not a good candidate for resection.

The researchers are continuing to assess music and sounds as seizure triggers. “Right now we’re trying to see if we should include, or increase, stimulation as a standard protocol when EEG is done in our hospital,” Antony said. They are also exploring whether certain types of sounds or music could ease seizures. 

‘A Meaningful Contribution’

Commenting for Medscape Medical News, Stern noted he was impressed that the case report involved the use of intracranial electrodes — an approach that, he said, goes beyond what most previous case studies have provided.

“It adds to the understanding in a detailed way and is a meaningful contribution,” he said. Additionally, the meta-analysis “allows for an up-to-date, comprehensive survey, which is also good as one tries to understand the condition as a whole and not as it occurred for just one person.”

Stern, who was not involved in the study, began writing about musicogenic epilepsy after treating a patient with the condition. “It’s an unusual condition and one that epilepsy specialists may see a few times in their career,” he said. 

He noted that his clinical experience, research, and readings have led him to reconsider what truly defines “music.” In musicogenic epilepsy, triggers vary widely and are often tied to specific songs or musical styles, he said. 

“The question, which I think is fundamental to this, is, how do we identify what is music and what is sound? One person’s music may be another’s noise,” Stern said.

For the patient he treated, the type of triggering music changed over time. “What we saw during the mapping of the seizure with functional MRI was the progression of the experience of the sound, which was the music, from auditory areas of the brain into the anterior temporal lobe, which is part of an emotional region of the brain,” he said.

“This led to the interpretation that maybe what makes something music to one person and not for another is the emotional experience of the sound,” he added.

Stern noted that more is starting to be known about this very rare condition, which has been around for a long time, because of technologic advances. 

“After initial reports, there wasn’t much to say about it. But with advanced imaging and other neurophysiologic techniques, we can understand the mechanisms or the localization of this epilepsy with more precision than was possible back then,” he said.

He also noted two recommendations for clinicians. First, if a patient reports that music is triggering seizures, it’s important to realize that “it’s not a novel, unique experience. It’s actually something that is well characterized,” he said.

Second, if medication isn’t working for seizures in such a patient, “having this type of epilepsy suggests the possibility of successful surgical treatment,” based on the meta-analysis, Stern concluded. 

Antony and Stern reported having no relevant financial relationships.