Temporal Lobe Epilepsy and Auditory SymptomsTemporal Lobe Epilepsy and Auditory Symptoms

To the Editor: In his Clinical Crossroads article about temporal lobe epilepsy, Dr Devinsky¹ stated that Vincent van Gogh had this disease. Arenberg et al,² however, have previously argued that van Gogh in fact had Meniere disease.

In any event, the physician in this case assumed that the patient's complaints had either a psychiatric or neurological origin. I suggest they are primarily otologic. The main clue is the patient's ear noises. As I have previously argued,³ there have been no documented cases of tinnitus in patients with neurological disease but an intact cochlea. In contrast, Devinsky suggested that the patient's epilepsy, with its associated tinnitus, arose from head injury. It is not clear to me, however, which structural brain disorder could cause tinnitus in the right ear and white noise in the left without any associated neurological or radiological abnormality. Mild head trauma or closed decelerative injury can damage delicate middle and inner ear structures, thereby provoking seizures.⁴ In this case, the patient's seizures included rotatory vertigo and vestibular hallucinations increasing on eye closure. On physical examination, eye fixation would be found to compensate for peripheral vestibular imbalance, if this were the source of the patient's vertigo. Furthermore, many psychologically distressing syndromes may have a component of inner ear imbalance. In their factor-analytic study of patients with Gulf War syndrome, for instance, Haley et al⁵ defined a factor that they labelled "confusion-ataxia," which was defined as involving rotatory vertigo, cognitive disruption, and memory retrieval.

In a familial syndrome of epilepsy with auditory features, Winawer et al⁶ found that neurological examinations were unremarkable, but that patients had multisensory symptoms that were similar to those seen in Meniere disease. Some had auditory hallucinations or seizures triggered by sounds or head injuries.