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Refractory nonconvulsive status epilepticus responsive to music as an add-on therapy: A second case

2010; Elsevier BV; Volume: 19; Issue: 3 Linguagem: Inglês

10.1016/j.yebeh.2010.07.025

1525-5069

Marcelo Miranda, G. Kuester, Loreto Ríos, Esteban Basáez, Sergio Hazard,

EEG and Brain-Computer Interfaces

In recent years there has been growing interest in the effect of music as alternative or add-on therapy in different neurological conditions [ [1] Sacks O. The power of music. Brain. 2006; 129: 2528-2532 Crossref PubMed Scopus (109) Google Scholar ]. However, there are only a few reports on its effects on epilepsy [ 2 Hughes J.R. Daaboul Y. Fino J.J. et al. The Mozart effect on epileptiform activity. Clin Electroencephalogr. 1998; 29: 109-119 Crossref PubMed Scopus (112) Google Scholar , 3 Hughes J.R. Fino J.J. Melyn M.A. Is there a chronic change of the "Mozart effect" on epileptiform activity? A case study. Clin Electroencephalogr. 1999; 30: 44-45 Crossref PubMed Scopus (41) Google Scholar , 4 Lin L.C. Lee W.T. Wu H.C. et al. Mozart K.448 and epileptiform discharges: effect of ratio of lower to higher harmonics. Epilepsy Res. 2010; 89: 238-245 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar ] and, specifically, on refractory epilepsy [ 5 Lahiri N. Duncan J.S. The Mozart effect: encore. Epilepsy Behav. 2007; 11: 152-153 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 6 Kuester G. Rios L. Ortiz A. Miranda M. Effect of music on the recovery of a patient with refractory status epilepticus. Epilepsy Behav. 2010; 18: 491-493 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar ]. We recently described a patient with nonconvulsive status epilepticus refractory to conventional therapy who showed a dramatic response to music [ [6] Kuester G. Rios L. Ortiz A. Miranda M. Effect of music on the recovery of a patient with refractory status epilepticus. Epilepsy Behav. 2010; 18: 491-493 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar ]. Herein, we add another case with status epilepticus with the same beneficial response, which supports the role of music as an alternative therapy in this condition. This 68-year-old man presented to the Oncology Department with brain metastases from lung cancer. He had undergone a partial lung resection, chemotherapy, and, 6 months earlier, whole-brain radiotherapy. The patient was assessed at the emergency unit because he developed an acute confusional state as a result of nonconvulsive status epilepticus (Fig. 1a ). He received intravenous phenytoin 15 mg/kg, followed by 300 mg daily with a poor response. He was therefore placed in a medically induced coma using continuous infusions of midazolam and propofol. Then, topiramate 200 mg/day and levetiracetam 3 g/day were added. Subsequently, the midazolam infusion rate was gradually decreased, but with reappearance of electrographic seizures accompanied by hemodynamic instability. After 7 days in this state his preferred music was added to the therapy. Different works by Mozart (not specifically the sonata for two pianos, K.448) and J.S. Bach were played continuously in his room, and before 8 hours had passed, the electrographic status epilepticus remitted (see Fig. 1b). During this period, his antiepileptic medications were not changed.