Musical hallucinosis in acquired deafness. Phenomenology and brain substrate.

Six subjects with musical hallucinations following acquired deafness are described. The subjects all experienced the condition in the absence of any other features to suggest epilepsy or psychosis. I propose a neuropsychological model for the condition consistent with detailed observation of the subjects' phenomenology. The model is based on spontaneous activity within a cognitive module for the analysis of temporal pattern in segmented sound. Functional imaging was carried out to test the hypothesis that musical hallucinosis is due to activity within such a module, for which the neural substrate is a distributed network distinct from the primary auditory cortex. PET was carried out on the six subjects to identify areas where brain activity increased as a function of the severity of the hallucination. In a group analysis, no effect was demonstrated in the primary auditory cortices. Clusters of correlated activity were demonstrated in the posterior temporal lobes, the right basal ganglia, the cerebellum and the inferior frontal cortices. This network is similar to that previously demonstrated during the normal perception and imagery of patterned-segmented sound, and is consistent with the proposed neuropsychological and neural mechanism.