Can "steroid switching" improve steroid-induced musical hallucinations in a patient with terminal cancer?

Our plain-English summary of Can "steroid switching" improve steroid-induced musical hallucinations in a patient with terminal cancer?, by S. Kanemura, H. Tanimukai, S. Tsuneto (Journal of Palliative Medicine, 2010).

The study

• Authors: S. Kanemura, H. Tanimukai, S. Tsuneto
• Journal: Journal of Palliative Medicine
• Published: 2010;13(12):1495-8
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The patient was a 57-year-old woman with malignant pleural mesothelioma. She had a past history of anxiety neurosis but not had any history of otological diseases. On admission to our hospice (day 1), she complained of dyspnea and wheezing associated with the progression of her underlying disease. After we started oral betamethasone (2 mg/d), dyspnea was alleviated and the frequency of wheezing was reduced. On day 3, she began to experience musical hallucinations that were manifested in opera/piano concert music and a child's voice. The episodes of musical hallucinations occurred approximately 10 times a day and disappeared spontaneously within several minutes. She had not experienced these symptoms before. We reduced the dose of betamethasone to 1 mg/d, but the musical hallucinations continued. Then on day 11, we switched betamethasone (1 mg/d) to prednisolone (10 mg/d) and we then gradually tapered off prednisolone. The frequency of musical hallucinations decreased and she ceased to experience musical hallucinations on day 29. However, on day 40, her dyspnea was aggravated again, so we started treatment with prednisolone (5 mg/d). Dyspnea was alleviated and no musical hallucinations occurred. On Day 51, dyspnea was worsened and we switched prednisolone to betamethasone (4 mg/d), which she hoped to use. The betamethasone alleviated the dyspnea but she developed musical hallucinations that were similar to the previous episodes. The musical hallucinations disappeared spontaneously 4-5 days later without changing the betamethasone. Musical hallucinations never occurred thereafter. She later died due to the exacerbation of disease.

In plain English

This article was a case report from a hospice in Osaka, Japan. It described one 57-year-old woman with malignant pleural mesothelioma, a long-time piano instructor, admitted in February 2009. The article did not discuss asbestos. On her second day, oral betamethasone (2 mg/d) was started for dyspnea and wheezing. On the third day she began having musical hallucinations, such as opera and piano concert music and singing voices, about 10 times per day, each ending within several minutes. Lowering betamethasone to 1 mg/d did not stop them. On day 11 the doctors switched to prednisolone (10 mg/d) and tapered it. The hallucinations decreased and stopped from day 29. Prednisolone restarted on day 40 caused no hallucinations. After a switch back to betamethasone (4 mg/d) on day 51, the hallucinations returned, then ended on their own 4 to 5 days later without a drug change. The authors noted other risk factors, including psychiatric illness, many central nervous system medications, and an affinity for music. The authors concluded that the hallucinations were closely correlated with betamethasone use and that steroid switching was effective in this case.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 57-year-old woman with malignant pleural mesothelioma, a former piano instructor, admitted to a hospice in Osaka, Japan, in February 2009
• Exposure: Steroid drugs: oral betamethasone (2 mg/d, later 1 mg/d, later 4 mg/d) and prednisolone (10 mg/d, then 5 mg/d). The article does not mention asbestos exposure.
• Main results:
  • Musical hallucinations began on the third day, after betamethasone 2 mg/d was started on the second day. They occurred about 10 times per day and each stopped within several minutes.
  • Reducing betamethasone to 1 mg/d on the seventh day did not stop the hallucinations.
  • After the switch to prednisolone and its taper, the hallucinations decreased and stopped from the twenty-ninth day onward.
  • Prednisolone 5 mg/d restarted on the fortieth day produced no hallucinations.
  • After the switch back to betamethasone 4 mg/d on the fifty-first day, the hallucinations recurred. They disappeared on their own 4 to 5 days later without a drug change and did not occur again.
• The authors' conclusion: The authors concluded that in this case the musical hallucinations were closely correlated with betamethasone use and that steroid switching was effective treatment.
• Limitations the authors state:
  • The authors stated that it remains unclear why the hallucinations stopped on their own while betamethasone was continued the second time.
  • The authors noted the patient had multiple other risk factors for musical hallucinations, including psychiatric disease and multiple medications affecting the central nervous system.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Hospice, Dyspnea.

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