Patients diagnosed with musical hallucinosis (MH) report hearing songs, melodies or orchestral music in the absence of a source of sound. Typically there is no delusional interpretation of the hallucinations.1

Because of the rareness of the disorder, reports of successful therapy have mostly been case studies. These have described treatment with neuroleptics, antidepressants and antiepileptics.

There is some evidence that a cholinergic deficit is likely to play a role in different hallucinatory syndromes. Based on this evidence we treated two cases of MH with cholinergic drugs.

Case reports

Case No 1

A 54-year-old male patient reported MH since the age of 34 years. The hallucinations took the form of different songs sung by a male voice which he could not attribute to anyone known to him. The melodies were partly accompanied by the sounds of a piano or guitar. Sometimes the patient would also hear orchestral music. The hallucinations were predominantly perceived on the right-hand side.

The patient described an increased intensity of the MH after a stroke at the age of 52 years. He had suffered infarctions of the left and right medial cerebral artery territories at the ages of 52 and 54 years, respectively. While no clinical symptoms remained of the infarction in the left hemisphere, the infarction in the right hemisphere had …