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Racked by Visions, Chopin May Have Suffered from Epilepsy

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Frédéric Chopin, the celebrated 19th century composer, suffered from grave illness toward the end of his short life. "I have been sick as a dog during these past two weeks," the composer reportedly said during a particularly difficult period in 1838. "Three doctors have visited me. The first said I was going to die; the second said I was breathing my last; and the third said I was already dead."

While Chopin is well known for his piano sonatas and nocturnes, the exact nature of his longstanding illness is less understood. Recently published research in the online journal Medical Humanities analyzes the often overlooked hallucinations that sometimes seized the composer. Scientists Manuel Vazquez Caruncho and Franciso Branas Fernandez attribute these hallucinations to frontal lobe epilepsy-- a new development in the ongoing quest to diagnose the Polish composer.

Chopin had frequent terrors, saw visions and, in perhaps one of the worst episodes, walked out while in the middle of a 1848 performance of his Sontata in B flat minor. In a letter Chopin later wrote, he attributed the scene to " those cursed creatures" he saw crawling out of the piano, similar to ones he claimed to have seen while on a trip to Spain.

The fact that Chopin experienced recurring hallucinations is a consistent symptom among patients with frontal lobe epilepsy, according to Carl Bazil, a professor of clinical neurology at Columbia University and Director of the Division of Epilepsy and Sleep at New York-Presbyterian Hospital/Columbia.

"There's no question that there are very accomplished artists that have epilepsy," Bazil said. "Van Gogh had a very well documented case of epilepsy. It's hard to prove which came first: is it the epilepsy that resulted in this burst of artistic creation, or is it the creativity that makes that circuitry overactive and prone to an epileptic seizure? We don't really know, but I think there is a relationship there."

While a number of neurological disorders could have accounted for Chopin's difficulties, much of Caruncho and Fernandez's analysis focuses on the composer's own letters and papers, as well as commentary by friends and students.

Temporal lobe epilepsy is defined by sudden onset seizures that arise in the temporal lobe, one of the brain's four sections, which also include the frontal, occipital and parietal lobes. This region of the brain is part of the limbic system, which controls emotions and memory.

The causes of temporal lobe epilepsy are varied, and can include traumatic injury, brain tumors, vascular malformations, developmental abnormalities and heredity factors. Unraveling the tangled web of ailments that plagued Chopin has long preoccupied researchers. Doctor Jean Cruveilhier treated the composer in his last months of life, and performed Chopin's autopsy, during which he removed Chopin's heart. The whereabouts and content of the autopsy report are unknown.

Initial diagnostic assessments pointed to tuberculosis. More recently, the consensus had settled on cystic fibrosis. Other possible diagnoses have included mitral stenosis, pulmonary emphysema, Churg-Strauss syndrome and allergic broncho-pulmonary aspergillosis. In 2008, a team of investigators from Warsaw's Institute of Molecular and Cell Biology proposed testing Chopin's preserved heart for the cystic fibrosis mutation. However, Polish authorities denied access to the tissue. Motivation for the testing apparently sprung from a desire to bring hope to people who presently suffer from the lung-clogging disease.

"If we can prove Chopin suffered from cystic fibrosis, it would be a huge inspiration for our patients," Polish cystic fibrosis specialist Wojciech Cichy told the AFP in 2008. "Especially children, to know they can accomplish a great deal like he did."

The recently published research by Caruncho and Fernandez emphasizes the links between temporal lobe epilepsy and complex hallucinations often marked by radical visual effects that are as fleeting as they are intense, matching Chopin's descriptions. Rather than mere distortions of light or sound, the visions can feature narrative components or characters and include strong smells or be coupled with "an old memory or familiar feeling," according to the NYU Langone Medical Center's Comprehensive Epilepsy Center's general list of temporal lobe epilepsy symptoms.

"Full of terrors and ghosts," was how Chopin's longtime companion George Sand (the pseudonym of Amandine Dupin, the Baroness Dudevant) described the monastery where the couple stayed while on a trip to Spain in 1838. The composer spoke frequently to Sand and her family members about his bouts with the visions. Sand's writing on their trip to Spain provides clues to some of Chopin's biggest episodes, with description of other incidents that are consistent with the memory loss often experienced by suffers of temporal lobe epilepsy.

"On return from my night explorations of the ruins with my children, I found (Chopin) at ten o'clock in the evening, pale in front of the piano, with wild eyes and his hair on end," Sand wrote. "He needed a while to recognize us." On another occasion, Sand reported that Chopin exclaimed to her, "Ah! I knew well you were dead!" Chopin later spoke of seeing "a cohort of phantoms" and that he sometimes felt "like steam."

Chopin's symptoms do not appear to have included hearing voices or other factors commonly associated with schizophrenia, bipolar disorder or other dissociative states. Chopin was 39 years old when he died in 1849.

"In some sense, none of this matters," said L. Michael Griffel, chair of Juilliard's music history department. "Where they were born, what they had, how much they paid someone. But on the other hand, we're here to study this. That's our purpose, and every detail is important. So when we find out that there could have been behavior and creativity on the part of a composer due to a given malady, whether mental, emotional, or physical, we care."

In addition to Chopin, Griffel listed Berlioz, Mendelssohn, Schumann and Schubert as examples of great romantic composers who suffered from health issues. "It seems to me that when people fear that time is limited, I think they do make an extra effort if they have that genius. I think they feel that they can't waste time," Griffel said.

Until now, Caruncho and Fernandez argue in their paper, analysis of Chopin's illness has not sufficiently taken his hallucinations into account.

Yet Chopin may have succumbed to a combination of ailments. "It's usually not deadly," Dr. Bazil said of frontal lobe epilepsy. "If you get an ongoing nonstop seizure, that's a life-threatening condition. But if someone dies of that, it's pretty obvious."

Whatever ultimately took down Chopin, report authors Caruncho and Fernandez caution this latest study of Chopin's ailments can only go so far. "We doubt that another diagnosis added to the already numerous list will help us understand the artistic world of Frédéric Chopin," the report concludes.