La neuropsicologia in Epilepsy is Dancing.
There
is a song about epilepsy that you can listen among those randomly
chosen from your playlists.
It
is the second track of the album The Crying Light,
released by Antony and the Johnsons in 2009. You need to listen to
this song many times, even in the different live versions, for the
infinite modulations of the unique voice of Antony Hegarty.
It's
not the first time that pop music sings epilepsy: Sallie Baxendale in
2008 published a review of the representations of epilepsy in
different genres, from hip-hop
to rhythm
and blues (1).
Many
of the ancient associations of epilepsy with madness, horror, and
lunacy can be found in these lyrics. However, the language of
epilepsy has also been appropriated by some musical artists to
represent a state of sexual ecstasy and dance euphoria.
Tuft
and Nakken (2) in 2014, added other aspects expressed in many pop
songs, and concerning social stigmatisation and artistic ecstasy.
In
the future it will hopefully be impossible to portray people with
epilepsy in the same negative light as previously. Epilepsy
associations the world over are working to prevent the spread of
prejudiced lyrics among people, but to the extent to which popular
music reflects popular attitudes to epilepsy, it appears as though we
still have a long way to go to de-mystify the disease and eliminate
prejudices.
In
Epilepsy is Dancing for the first time, the terms are not
negative nor pessimistic. In addition, if in the official video a
seizure turns into a paradisiacal dance, the lyrics refer to the
different clinical manifestations of the different forms of seizures.
Beyond
the relationship between epilepsy and evil spirits, and the fight
against stigma, the song gives an apparently dreamlike description
but, in fact, it contains an objective report of what a seizure is.
Furthermore,
the lyrics are rich with references to the neuropsychology of
epilepsy.
Let's
start with the title. In the popular culture, there is an ancient
association between epilepsy and dance, a dance that can become
contagious (1).
Is
this true from an epileptological perspective?
Yes,
in some cases, Epilepsy is Dancing.
In
the clinical and scientific literature, there are few cases of
seizures manifesting as dancing in epileptic adults. The following
three cases are quite well documented.
Kuscu
and colleagues in 2008 (3) reported the case of a 17 years old girl
presenting temporal epilepsy due to left mesial temporal sclerosis.
Until the age of 14, she had experienced rare seizures with agitation
and hallucintaions, treated as psychotic episodes. Three years later
the frequency of seizures had increased and she was hospitalized to
underwent neurological, electrophysiological and neuroradiological
examinations. The EEG recordings showed paroxysmal activity in the
temporal lobe, that partially spread to the left frontal lobe. After
the surgical treatment with selective left amygdalohippocampectomy
the girl has been seizure-free.
The
videorecordings show different seizures starting with auras, during
which she was able to report the arrival of the seizure, and
continuing in unconscious complex motor behaviors - like a ballet –
accompanied by her singing.
The
second case was published by Barker and colleagues in 2011 (4) and
refers to a 60-year-old woman with temporal lobe epilepsy. Her
seizures showed some EEG abnormalities in the left temporal lobe, and
shortly after, the bilateral foot movements emerged, gradually
tooking the form of tap dancing.
In
the last case report (5) are presented the clinical data of a
39-year-old man with temporal lobe epilepsy and EEG abnormalities
suggestive of a left temporal focus. In the video, the seizure starts
with the typical oral automatisms of temporal seizures, followed by
the complex dancing movements, suggestive of frontal involvement.
So,
epilepsy is dancing, at least in some cases and for some seizures.
However,
it is a dance caused by the paroxysmal activity of the brain which
has no beneficial effects. On the contrary, it may affect the
activities of daily living, personal relationships, work activities
and quality of life. Therefore, it is a dance that, like all
seizures, need to be treated as a clinical manifestation.
In
Epilepsy is Dancing one can find much more from a
neuropsychological point of view: in the lyrics – verse by verse -
there are many of the clinical manifestations of different
epilepsies.
Epilepsy
is dancing
She's
the Christ now departing
The
first verse include a reference to Christ, a kind of experience
similar to the mystical and religious hallucinations observed in
temporal lobe epilepsy, with individual specific contents depending
on the cultural context.
As
suggested by Tuft and Nakken (2), and considering that Antony Hegarty
is also a visual artist, the verse may refers to the Transfiguration
(1516-1520) by Raphael. In addition, here there is an identification
between the two figures of Christ and the epileptic, overcoming their
spatial and metaphysical separation.
As
pointed out by Janz (6), there are
only
two characters among the 26 represented in whom we see the two eyes.
Christ’s look is lost in the beyond while the eyes of the young boy
are bulging, the right eye directed towards Jesus and the left one
towards his father.
By
synchronizing both scenes Raphael demonstrated a significant
correspondence between Christ and the epileptic boy, which reveals
the epileptic seizure as a symbolic representation of a transcendent
event.
Also
Mann (7), in reporting an epileptic case study, refers to the
Transfiguration and to the
Christian symbolism:
Behind
Christ, the light of the cloud reminds one of the divine voice that
asserted he was the beloved son, while the son’s mouth lets out
that epileptic scream... So, the vision is doubled by two vocal
manifestations, a divine and an evil one.
If
the boy is the antithesis down on the dark and tormented earth,
clearly, Jesus represents the divine thesis up in the bright and
serene heaven.
Many
prejudices against epilepsy originated from this classical
representation.
In
the verse She's
the Christ now departing, the
two figures seems to become one and it's no coincidence that a girl
(in the official video is interpreted by Johanna Constantine) is
having a seizure.
The themes regarding the feminin are always present in the interviews
and in the artistic expressions of the transgender singer and artist.
And
I'm finding my rhythm
As
I twist in the snow
The
EEG rhythm - and its abnormalities - is the hallmark of the epileptic
disorders. Each individual with epilepsy shows a quite typical set of
seizures, reflecting specific anatomo-functional alterations.
For
example, the EEG of generalized tonic-clonic seizures can show a
desynchronization, followed by recruiting rhythms in the tonic phase
and by slow waves decreasing in frequency in the clonic phase.
Rhythm
abnormalities are accompanied by clinical manifestations: the tonic
phase take the form of muscle contraction, with rigidity and axial
extension, apnea and cyanosis are common; in the clonic phase,
bilateral convulsive movements occur.
All
the metal burned in me
Down
the brain of my river
Pathophysiologically,
a seizure results from a paroxysmal electrical discharge of
synchronized groups of neurons. The cell membrane of the
epileptogenic neurons undergo a prolonged depolarization and action
potential occurs, corresponding to a spike on the EEG. The paroxysmal
depolarization then alters the normal balance between pumps and
channels that regulates metals and electrolytes (sodium, potassium,
calcium and chlorides) in the membrane of the neuron.
That
fire was searching
For
a waterway home
The
activation of inhibitory mechanisms terminates the seizure and
restores the balanced excitatory-inhibitory environment. The regular
exchange of ions on the two banks (intracellular and extracellular)
of the neuronal membrane is gradually reached.
I
cry glitter is love!
The
clinical manifestations of sensory seizures include visual, auditory,
olfactory, or gustatory phenomena. In the visual modality, the
sensory effects may consists of glitter, colored dots, or lights,
appearing in the visual field. In occipital epilepsy, elementary -
scotomas and phosphenes – and complex – illusions and
hallucinations – phenomena are reported.
 |
Elementary
visual phenomena in occipital seizures
|
Other
types of seizures can occur with affective symptoms: sudden, intense
and unjustified emotions, often negative (fear, sadness) and more
rarely positive (happiness, ecstasy).
My
eyes pinned inside
With
green jewels
Hanging
like Christmas stars
From
a golden vein
Here
is another reference to visual illusions and hallucinations.
The
green jewels hanging in the eyes, and the supposed reflex response,
evoke to the clinician the small eyelid movements observed in some
seizures, from fluttering to myoclonic jerks. In children, eyelid
myoclonia with or without absences is a form of epilepsy manifesting
with myoclonic jerks, eye closure-induced seizures and
photosensitivity.
Golden
vein
is also the title of a 1995 Cocteau Twins song - Oh,
in their eyes and then...
As
I came to a screaming
Hold
me while I'm dreaming
Screaming
is typical of frontal seizures originating in medial regions (the
supplementary motor area and the cingulate gyrus) and involving
asymmetrical, bilateral posturing and/or complex automatisms such as
swimming, pedaling and dancing. These hypermotor seizures, can
be accompanied by facial grimacing, vocalizations or speech arrest,
and are most often nocturnal.
For
my fingers are curling
And
I cannot breathe
Tonic
seizures manifest with diffuse muscle contraction of head, trunk,
limbs, and hands, accompanied by loss of consciousness, apnea and
typical EEG rhythm abnormalities.
Then
I cried in the kitchen
How
I'd seen your ghost witching
As
a soldering blue line
Between
my eyes
Seizures
from the occipital and the parieto-occipital
lobes are characterized by visual and spatial phenomena. Perceived
objects may appear diminished or enlarged
(metamorphopsia),
stationary objects seen as moving or, in more complex forms, objects
are seen with inappropriate orientation in space.
In
teleopsia,
an error occurs in perceiving the distance of objects; in enhanced
stereoscopic vision,
near object are perceived very close and distant object appear very
far away. Autoscopic
seizures originate in the temporo-parietal regions and are
characterized by the perception of the image of one's own body in the
outer space, accompanied by negative emotions and confusion.
Cut
me in quadrants
 |
Gray
H. Anatomy of the Human Body, 1918
|
Leave
me in the corner
The
end of the parieto-occipital seizures manifests with transient
numbness, inability to move in the absence of loss of strength and
post-ictal blindness.
In
the post-ictal phase the dreaming state terminates and consciousness
gradually returns: the dance is about to end.
Oh
now it's passing
Oh
now I'm dancing
Some
neurological and neuropsychological references in the lyrics probably
emerge from a retrospective clinical reading and were unintentional.
However, there seems to be some evidence of a preparatory study of
epilepsy conducted by the author, leaving aside any metaphysical or
religious interpretation.
In
Epilepsy is Dancing,
Antony Hegarty also plays an educational role in spreading the
objective knowledge about epilepsy in popular culture.
And
now, the full lyrics.
Have
a good listening and knowing.
Epilepsy
is dancing
She's
the Christ now departing
And
I'm finding my rhythm
As
I twist in the snow
All
the metal burned in me
Down
the brain of my river
That
fire was searching
For
a waterway home
I
cry glitter is love!
My
eyes pinned inside
With
green jewels
Hanging
like Christmas stars
From
a golden vein
As
I came to a screaming
Hold
me while I'm dreaming
For
my fingers are curling
And
I cannot breathe
Then
I cried in the kitchen
How
I'd seen your ghost witching
As
a soldering blue line
Between
my eyes
I
cry glitter is love!
My
eyes
Pinned
inside
Sea
green jewels
Hanging
like Christmas stars
From
a golden vein
Cut
me in quadrants
Leave
me in the corner
Oh
now its passing
Oh
now Im dancing
Update #1 (January 29th, 2016). The same day when I was writing this post, in Oslo (Norway), Mia Tuft and her colleagues Gjelsvik and Nakken were submitting the paper Epilepsy is Dancing to the journal Epilepsy and Behavior: wonderful things can happen.
If you want the full-text, please write me at t.metitieri@gmail.com.
Update #2 (February 1st, 2016). I sent Antony Hegarty/Anohni the paper by Tuft & coll. and my post, via facebook. This was her reply: "thanks for the info! its very interesting! Anohni", wonderful things continue.
1. Baxendale S. The representation of epilepsy in popular music. Epilepsy Behav. 2008;
12(1):165-169.
2. Tuft M, Nakken KO. Epilepsy and stigma in popular music. Tidsskr Nor Laegeforen.
2014;134:2290-3.
3. Kuscu DY, Kayrak N, Karasu A, Gul G, Kirbas D. Ictal singing due to left mesial temporal
sclerosis. Epileptic Disord. 2008;10(2):173-6.
4. Barker AS, Bowen JR, Sharrack B, Sarrigiannis PG. Tap dancing in epilepsy. Epilepsy
Behav. 2011;20(1):150-1.
5. Bagla R, Khoury JS, Skidmore C. Teaching Video NeuroImages: dancing epilepsy.
Neurology. 2009; 72(22):e114.
6. Janz D. Epilepsy, viewed metaphysically: an interpretation of the biblical story of the
epileptic boy and of Raphael's transfiguration. Epilepsia. 1986;27(4):316-22.
7. Mann MW. The epileptic seizure and the mystery of death in Christian painting. Epilepsy
Behav. 2010; 17(2):139-46.
For more information about epilepsy:
- ILAE - International League Against Epilepsy http://www.ilae.org/ and
https://www.epilepsydiagnosis.org/
- LICE – Lega Italiana Contro l'Epilessia http://www.lice.it/
