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BRAIN and NERVE Volume 66, Issue 5 （May 2014）

BRAIN and NERVE 66巻5号（2014年5月発行）

Japanese English

症例報告

抗てんかん薬で効果を認めた音楽性幻聴の83歳男性例 Successful Treatment with Anti-Epileptic-Drug of an 83-Year-Old Man with Musical Hallucinosis 二村明徳 ¹ , 加藤大貴 ¹ , 河村満 ¹ Akinori Futamura ¹ , Hirotaka Katoh ¹ , Mitsuru Kawamura ¹ ¹昭和大学医学部内科学講座神経内科学部門 ¹Department of Neurology, Showa University School of Medicine キーワード：音楽性幻聴 , シャルルボネ症候群 , てんかん , 認知症 , musical hallucinosis , Charles Bonnet syndrome , epilepsy , dementia Keyword: 音楽性幻聴 , シャルルボネ症候群 , てんかん , 認知症 , musical hallucinosis , Charles Bonnet syndrome , epilepsy , dementia pp.599-603

発行日 2014年5月1日 Published Date 2014/5/1

DOI https://doi.org/10.11477/mf.1416101799

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3年前から難聴を自覚していた83歳右利き男性が，突然に童謡の「とおりゃんせ」が聴こえるようになった。その後，童謡だけでなく民謡や軍歌，君が代なども聴こえた。¹²³I-IMP脳血流SPECTでは右側頭葉・頭頂葉に血流低下が，左側頭葉・頭頂葉に血流増加を認めた。発作性の嘔気や頭重感，脳血流の左右差などから側頭葉てんかんを疑い，カルバマゼピン200mg/日を投与したところ，音楽性幻聴は軽快し，嘔気・頭重感は消失した。抗てんかん薬が効果的であった聴覚性シャルルボネ症候群により発現した音楽性幻聴と推定した。

Abstract

An 83-year-old man with 3 years symptomatic hearing loss suddenly experienced musical hallucinosis. He heard children's songs, folk songs, military songs, and the Japanese national anthem for seven months every day. He sometime had paroxysmal nausea, dull headaches and depressive mood. On examination he had no psychosis or neurological symptoms except sensorineural hearing loss in both ears. MRI brain imaging and electroencephalography showed no significant abnormalities, however ¹²³I-IMP brain SPECT showed decreased activity in the right temporal lobe and increased activity in the left temporal and parietal lobes. Late phase ¹²³I-iomazenil brain SPECT showed decreased accumulation in the right temporal lobe compared to the early phase. This indicates right temporal lobe epilepsy. He was diagnosed with epilepsy because of paroxysmal nausea and headache and the laterality of ¹²³I-IMP brain SPECT and ¹²³I-iomazenil brain SPECT. The musical hallucinosis was much reduced by carbamazepine 200mg per day. Nine months after beginning carbamazepine we detected decreased activity in the right temporal lobe and increased activity in left temporal and parietal lobes was improved. We do not believe he had epileptogenic musical hallucinosis because his musical hallusinosis was neither paroxysmal nor lateral. We diagnosed auditory Charles Bonnet syndrome with onset 3 years after sensorineural hearing loss due to reversible epileptic like discharge in temporal and parietal lobes. There is no established treatment for musical hallucinosis, but anti-epileptic drugs may be of some help.

(Receieved July 10, 2013; Accepted October 24, 2013; Published May 1, 2014)