The mind with a radio of its own: a case report and review of the literature on the treatment of musical hallucinations

Abstract

Musical hallucinations (MH) have been labeled Oliver Sacks syndrome, and in the majority of cases, they occur in the context of a hearing loss. In these instances, they have been described as auditory Charles Bonnet syndrome because they are thought to represent a cortical release phenomenon. Patients with MH tend to have intact reality testing, and as such, the condition may also be described as musical hallucinosis. The temporal course of MH is variable, but given that they may improve or remit with time, education on their benign nature is often sufficient. MH also may improve when hearing loss is reversed. The use of ambient noise potentially ameliorates mild to moderate MH; however, where this is insufficient, somatic treatments may be considered. Case reports have documented successful use of low-dose antiepileptics, atypical antipsychotics and donepezil. We present a case of a 52-year-old man who received only partial relief from serial treatment with several psychotropic agents. He developed major depression with suicidal ideation in the context of persistent, intrusive MH that were refractory to several medication trials, and whereas a course of electroconvulsive therapy led to remission of depressive and suicidal symptoms, it provided only transient relief of his MH. In this article, we also provide a review of the literature on the neurobiology and treatment of MH.