Did Chopin Have Temporal Lobe Epilepsy?

Frederick Chopin is not only one of the greatest composers this side of history, but also, a paleopathologist’s delight. He died at the age of 39, which, even by the standards of those days, was quite young. There were several interesting correlated family ailments which has sparked the minds of the medical folks. In this article (1), the authors present the contentious issue that Chopin was also suffering from Temporal Lobe Epilepsy. There has been strong conjecture that Chopin suffered from Cystic Fibrosis, since his sisters and his father were all prone to recurrent lung infections. Interestingly, the Polish Government has apparently turned down a request to test for CF on his heart (which they still have preserved, apparently).

As with any genius, Chopin was perceived to be melancholic, and suggestions have been made suggesting that he had Bipolar disorder or major depressive disorder. Without going into the fallacies of making such a suggestion, I will try to contain myself for the time being to the issue of Chopin having temporal lobe epilepsy.

One of the major arguments in support of the theory that Chopin had temporal lobe epilepsy were the recurrent hallucinations he used to suffer from. Starting from the instance where he fled the room after imagining monsters emanating from his half open piano to his delusional imagination of the death of George Sand all the while playing himself to somnolence, and believing he had died. There were several other occasions on which he succumbed to these complex visual hallucinations and they mostly coincided with his being acutely sick. For example, the occasion when he was ill with severe fever and hemoptysis (February, 1837) or when he had an overwhelming dental infection, leading to a high fever (1844). The authors collate more such evidence of Chopin’s hallucinations and arrive at the following common points in all of them:

These accounts suggest that the hallucinatory episodes had some common characteristics. First, he seems to have retained insight and was able to recall the hallucinations in detail. Second, he appears to have experienced some episodes as unreal and seemed to be disconnected from reality. Third, the hallucinations occurred mostly in the evening. Fourth, some episodes coincided with acute infections and fever. Fifth, it seems clear that Chopin had complex visual hallucinations: the Manchester and Majorcan episodes were probably Lilliputian hallucinations. However, we neither know what these creatures were like nor their colour. It is probable that they caused him mild anxiety, but otherwise
no one noticed anything abnormal. Sixth, there are no reports of Chopin having neurological deficits or other symptoms. Seventh, the idea and images of death were recurrent.

The list of potential differentials is long:

1. Psychiatric conditions such as Schizophrenia but in these cases the hallucinations are mostly auditory
2. Migraine visual aura followed  by headache. Ruled out as he did not really have headaches. He had facial neuralgias due to poor dental status, though.
3. Chopin took laudanum (opium), and in my opinion, this forms the best explanation possible for the hallucinations (probably better than Temporal Lobe Epilepsy). As the authors concede, toxic hallucinations can be of any form, synesthetic, visual, auditory or tactile. Although they contend that Chopin was not always on medication prior to the hallucinations, can be easily ascribed to recall bias. Especially since this was not recognized to be a possible adverse effect in those days.
4. Hypnogogic and Hypnopompic hallucinations occur when the individual is falling asleep or waking up respectively. Since Chopin is not seen to have been drowsy on some occasions when these hallucinations struck, they get ruled out straightaway. As do other causes like Narcolepsy or cataplexy. On another note, another great personality was alleged to suffer from Hypnogogic hallucinations: Richard Feynman. He was given this diagnosis when he was being examined by Psychiatrists to assess his fitness to serve in the army. Thankfully for Physics, and Physics groupies (like ME!) he was rejected!
5. Lhermitte’s Syndrome is also another close fit as it matches the time frame, the nature of hallucinations and time of onset as well. However, the problem lies in that the patient perceives them to be not real. Chopin seemed to have been so unsettled by these visions that he often had to remove himself from the place in order to escape them. He also appeared to have an almost delusional belief in the death of George Sand when Sand was late in returning one tempestuous night.
6. Peduncular hallucinosis secondary to rostral brainstem lesion has also been suggested, but the lack of other characterizing features makes it a highly difficult diagnosis to go by.

Following in line with the arguments of the authors, temporal lobe epilepsy does seem to be a close fit, although I somehow feel toxic hallucinations secondary to laudanum abuse maybe a more plausible explanation. Maybe it is my tendency to believe in Occam’s Razor, or maybe my clinical inexperience (I am yet to see a real life case of Temporal Lobe epilepsy), I believe temporal lobe epilepsy is trumped by toxic hallucinations.

No matter how cynical I am about adding another list to the already long list of diseases this unfortunate person is conjectured to have suffered from, I completely agree with the authors when they say:

We doubt that another diagnosis added the already numerous list will help us understand the artistic world of Frédéric Chopin, but we do believe that knowing he had this condition could help to separate romanticised legend from reality and shed new light in order to better understand the man and his life.

So, what do you think? Do you think Temporal Lobe epilepsy is a sound proposition? Or would you like to throw in another name into the mix?

References:

1. Vazquez Caruncho, M., & Branas Fernandez, F. (2011). The hallucinations of Frederic Chopin Medical Humanities DOI: 10.1136/jmh.2010.005405