Hyderabad-based Ajay Krishna (name changed) — like many others around him — likes songs. Unlike most of them, he can actually sing well, and considers it a passion. So much so that he gets requested to sing.
What’s even more uncommon is that when the 45-year-old schoolteacher sang songs by Kishore Kumar, especially the romantic ones, he would experience jerky movements on his face, lips, and his hands.
What was definitely bizarre is he actually passed out while completing a Kishore Kumar song at a private gathering!
It led his loved ones to fear the worst. But he recovered, and initial testing found no cardiac or cardiac-related event, as doctors had suspected.
Except, this did not seem to be a one-off thing.
Ajay had apparently experienced quite a few episodes of consciousness loss after singing romantic songs, especially those of Kishore Kumar, of whom he is a fan.
It was only when Ajay visited Dr Sudhir Kumar, a neurologist at the Apollo Hospitals in Hyderabad, that he truly understood what was happening: It was all due to a rare condition called musicogenic epilepsy.
Related: How IISc helped decode brain scans to identify type of epilepsy
Cardiovascular scare
Ajay’s most recent episode of fainting is said to have occurred when he was singing at a private gathering.
He had sung several numbers of other singers when the gathering urged him to perform the popular Kishore Kumar song Pal pal dil ke paas.
A few minutes later, as he was nearing the end of the song, he collapsed on the stage, unconscious.
His pulse rate was 110 beats per minute (bpm) and his blood pressure 160/100. The normal numbers are 60-72 bpm and 120/80.
Ajay was immediately shifted to a hospital for evaluation, but he regained consciousness on the way.
“Like in many cases (of musicogenic epilepsy), people first suspect a cardiovascular issue and rarely do they think it could be neurological in nature,” explained the doctor.
“However, his ECG, echocardiogram and cardiac evaluation were normal. Thankfully, the doctor referred him to me to rule out any neurological causes,” said Dr Kumar.
Why did the patient collapse?
Kumar requested Ajay to narrate the entire sequence of events, who said he was feeling happy at the start of the song but felt a strange sense of extreme fear and anxiety as he neared its end.
Ajay said he also began to experience jerky movements on his lips, face, and hands.
“This is all he could remember. He fainted soon after that. When I probed further, he mentioned that he had experienced similar symptoms earlier as well while singing romantic songs,” said Dr Kumar.
Ajay told the doctor that he had noticed a pattern, that whenever he faced similar symptoms after singing some romantic songs, he would immediately discontinue singing and that would help him recover in a few minutes.
Dr Kumar explained that Ajay was a Kishore Kumar fan and would emotionally connect with the lyrics of those songs.
He had recently lost his wife, who used to accompany him during his performances.
Hence, the changes in his emotional state and mood were associated with singing and were magnified since her passing.
Ajay would associate the lyrics in the song with his wife, and hence would go through epilepsy attacks.
Related: Karnataka launches first Brain Health Clinic in Bengaluru
A diagnosis of musicogenic epilepsy
Dr Kumar immediately diagnosed Ajay’s condition as a case of musicogenic epilepsy.
Epilepsy is a common neurological condition that causes unprovoked, repeated seizures. It is not limited to people within a specific age range
Musicogenic epilepsy is a reflex epilepsy where any kind of music can trigger seizures.
It could be due to either instrumental music, merely some notes in a song, or even the act of singing or listening to someone else sing, explained Dr Kumar.
He told South First: “I have seen at least three such cases recently, and about five more when I was working in Karnataka and Tamil Nadu. These cases often go unreported as people do not know this neurological condition.”
Neuroscientist and Researcher Dr Akhil Raj from the Nonpareil Healthcare Centre in Bengaluru explained to South First that musicogenic epilepsy is usually a temporal-lobe seizure. It is estimated that one in 10 lakh people experience this kind of epilepsy.
Within that small group, each person can have different triggers for seizures. Some can even get seizures while dreaming of music.
“It is related to hyperexcitable cortical regions, which could be stimulated to different degrees and extents by various musical stimuli. A person tends to associate the lyrics, notes, or the music to their life, and these emotional reactions can lead to discharges in the brain and could lead to seizures,” he said.
What lies ahead?
When Ajay’s brain MRI and routine EEG were normal, Dr Kumar insisted that he actually sing Pal pal dil ke paas.
This time, the EEG showed epileptiform discharges from his right temporal lobe. Ajay also began to experience emotions of fear and anxiety, followed by jerky movements of the fingers.
Then, when Ajay was asked to stop singing, the EEG normalised.
“I did not want him to start on any long-term anti-epileptic drug (AED) for this as this was only a reflex seizure. Discontinuing singing was also not an option for him, as he enjoyed singing. So I told him to take an AED one hour prior to any of his performances. He has continued to sing Kishore Kumar’s romantic songs,” Dr Kumar told South First.
He added that accurate identification and proper treatment could result in an excellent outcome for Ajay.
“Many do not go to doctors (for such symptoms) as they won’t know it is related to the brain. They generally ignore it as they tend to become normal after a brief episode of falling unconscious. It is a rare condition, but I feel it may be under-reported or under-diagnosed,” he told South First.
Dos and Don’ts for epileptic episodes
It is a myth that a person fainting due to epilepsy recovers if given a bunch of keys or made to smell stinky socks, said Dr Kumar.
Explaining some steps to follow, he said that in any epilepsy episode, the person tends to remain unconscious for three-four minutes and wakes up on their own.
However, there is a risk of injury due to the fall or bleeding due to biting of the tongue. The risk is much higher if musicogenic epilepsy happens when one is driving.
Here are few things people should do:
- Ensure that the epileptic person is in a safe place and is not hurt due to sharp objects around, or anything else.
- If they are unconscious, turn them on one side.
- Do not give any water to drink. This may get into the lungs.
- Do not make them sit up immediately.
