It was not unusual for Martha Curtis (IAC 68-70, IAA 70-74, IAC St 74, IAC Fac 96-97) to have a seizure while performing on stage. Often, the seizures had few visible outward signs. "I never knew how far it would go. If it didn’t get to my hands or move to my body then I knew that I could just live in that shock of terror by myself," she explained. Anyone sitting in the audience would be unaware of the storm going on inside the violinist’s brain. For many years Martha herself did not fully grasp how her seizures had altered her brain or what those changes meant for her future as a musician.
Martha’s seizures started when she was just three years old. After a high fever and a bout with the measles she experienced an unrelenting and life-threatening seizure that would not stop without medical intervention - status epilepticus. She was rushed to the hospital, treated with anti-seizure medications and held there for weeks.
Before taking Martha home from the hospital, doctors urged her mother to resist her instincts to coddle her child after the traumatic ordeal. The seizures were no reason to keep her from experiencing a normal childhood, they counseled. After the ordeal, Martha’s mother took their advice to heart and young Martha enthusiastically embraced life - especially music. "My mother was a pianist and she noticed how alive I became when there was music," remembered Martha. "She noticed how much I reacted to music. It felt good to make music. I don’t know any better way to put it than that. I know there are lots more heady things to say - but it has always just felt good to play."
Although she did not realize it until much later, Martha was getting much more than satisfaction from her musical efforts. Some of the areas in her brain that were damaged are typically responsible for perceiving sound and making music. Every time she pushed herself musically, her young brain was rewiring itself - forming new connections, adapting and reorganizing to meet the rigorous demands she had placed on it.
Martha’s doctors would eventually pinpoint the amygdala as the culprit in producing her seizures. This small almond-shaped piece of brain is located in the medial temporal lobes, buried deep behind one’s ears. Among its many functions, it controls fear - and that is exactly what it produced in Martha when the neurons of this area began to fire away immediately before a seizure. "The first sensation would start right in my chest. I knew that there was something on the horizon moving in to kill me." A mild seizure would begin and end with this sensation. In a more severe seizure, the amygdala would start a chain reaction in her brain, involving other areas and producing symptoms including involuntary movements and even loss of consciousness.
Early in her life, Martha realized that music could calm her symptoms - or inflame them. She found that she was often most susceptible to seizures when sitting in the audience at a concert or playing a less challenging part in an ensemble. "I could never afford to listen to music as just a wash of sound. I learned that as soon as the concert started I would try to jam the circuits." To hold the seizures at bay, she would concentrate and analyze every element of a piece.
Determined to keep her seizures from interfering with her music and her career, Martha graduated salutatorian from Interlochen Arts Academy and went on to Eastman School of Music. Her teacher at Eastman, Charles Castleman, remembers her as an incredibly determined student. "I was aware she had seizures, but never witnessed them," he explained. "But it was a constant concern for her that they not impinge upon her education and performance." Castleman proved to be an ideal mentor for Martha. Not only was he an exceptional teacher, he had also studied physiological psychology at Harvard and had insights into brain function. Even after she left Eastman, Martha corresponded with her teacher about music - and her brain.
To control the worst of her seizures, Martha used medications including Phenobarbital, a barbiturate, but it came with significant side effects. While studying at Eastman, she became so frustrated with the depressant effect of the medication that at one point she stopped taking it - not long afterward she had a severe seizure.
She and her doctors tried numerous medications to find one that was both effective and had limited side effects. "They helped prevent the seizures but were all downers," said Martha. "I never missed a lesson, a rehearsal or a concert, but that’s mostly because I have a husband who could help wake me up." Even toxic levels of her medication, however, could not stop her seizures entirely.
Despite her talent and accomplishments as a musician, Martha found that it was impossible to keep the seizures from affecting her career. In 1990, as she performed with an orchestra on stage, Martha began to feel the familiar but terrifying sensation of a complex partial seizure. Because this happened as often as five times a month, her colleagues had learned to recognize the subtle outward cues of Martha’s personal terror. Two musicians discretely led her off stage to a side room where she could recover. But Martha did not recover. As the concert continued, she sat in a room offstage and a chain reaction took place in her brain until the entire organ was involved. This potentially fatal condition is known as a tonic clonic or a grand mal seizure - and it was her first in more than a decade.
At intermission, her husband Walter, a cellist in the orchestra, retreated backstage to see Martha and was surprised to find a medic attending to her. Still disoriented, Martha insisted on returning to stage. "That would have worked if it had only been a complex partial seizure," explained Walter. "But a grand mal seizure is such a severe occurrence that the medic thought she shouldn’t go - and I agreed with him." Walter prevented her return to the concert by refusing to hand over her violin. This was a bitter turning point for Martha and one that threatened her continued involvement in music. Even worse, within a month’s time she experienced four more tonic clonic seizures.
As the medications became less effective and the seizures more frequent, Martha sought help from Dr. Hans Lnders of the Cleveland Clinic who accepted her as a patient in the epilepsy monitoring unit. Martha was ecstatic to have even a chance to see if they could help her. "I felt like I had just been taken into the Boston Symphony!"
The first step in understanding her seizures was for her doctors to see one first-hand and monitor her brain during the seizure. They took Martha off her medications and prepared to monitor her brain activity by inserting an electrode wire through her jawbone and into her skull. And then they waited. She passed the time by practicing while the doctors watched the electrical signals from her brain. They found that even when she seemed to be functioning normally, her brain was behaving strangely - neurons fired irregularly, disrupting the activities of the healthy parts of her brain. When the seizure finally came several days later, the electrodes in her brain registered its origins in a small part of the right frontal lobe. It was good news that the seizures were localized and opened the door for a surgical solution - the doctors could remove the problem area.
Because brain surgery is such a radical procedure and the organ is still so little understood, collateral damage is not uncommon when a portion of the brain is removed. Surgeons make every attempt to minimize the damage. They do not want to destroy a person’s ability to speak or understand language or any other function that we consider vital to a "normal" life. And for Martha, they did not want to wipe out her livelihood and passion. As they prepared to remove a piece of Martha’s brain, they needed to consider a difficult question - where does her music live?
Dr. Luders and the other doctors explained to Martha and Walter the various risks of the procedure. She could experience partial paralysis. She could even die on the operating table. He also explained that she could lose her musical memory. "When he first explained that to me, I thought he meant that I might lose my ability to remember or memorize music. But that wasn’t it at all," said Martha. "He was telling me I could lose my ability to understand or even grasp the concept of music." When doctors were counseling Martha about the operation, she was visited by a neurologist who was also an amateur musician. To illustrate the dangers of tampering with the brain, he told Martha about an accomplished pianist that he had once treated. After a serious head injury the pianist was no longer capable of perceiving music. Everything was just noise.
Despite the dangers, Martha decided to move forward with the surgery because she felt her seizures had nearly taken away her ability to make music. But the potential outcomes still weighed heavily on her. "In one of my last concerts before my surgery, I played the Beethoven violin concerto. I cried through the slow movement. I knew that if I couldn’t play anymore that I would cry for a long time. But if I could never even hear Beethoven again, I didn’t think I could guarantee my sanity. I hoped that if I lost my music, that they took it all. I didn’t want to remember what I had lost."
The day of the surgery came and Martha and her doctors successfully made it through. She spent three days in intensive care before picking up her violin. Still weak, she played the Bach D minor Sarabande as her family and doctors watched. She performed for her small audience with her eyes closed because she dreaded the looks that she might see if she looked at their faces. Yes, she heard music and that was a good sign - but what if the music she perceived was not what she was actually playing? After finishing the piece, she opened her eyes to look at her mother and husband. To her great relief, they were smiling.
Relief quickly turned to disappointment when Martha continued to have seizures. Eleven months after the first surgery, Martha returned to the operating room. For a moment during her second recovery, she experienced exactly what she feared most. As she lay in bed, Walter picked up his cello and began to play. "She said to me - that sounds terrible. But I was just playing a scale," said Walter. "She seemed to hear each pitch as several pitches a half step or less apart. She could not hear music in a normal way. I just thought ‘oh no.’"
As the swelling in her brain went away her ability to hear music returned - but so did the seizures. The surgeons were hesitant to try again for fear of causing permanent damage to their patient. But despite the close-call with losing her music forever, Martha was adamant that they continue.
 To identify and target the troublesome portion of her brain once and for all, doctors inserted a mesh containing electrodes underneath her skull. They soon found that the seizures were starting in one remaining piece of the Amygdala. They would try once more to remove the source of her seizures.
Success. After the third surgery, Martha could not only hear and play music - she could do so without the constant threat of a seizure. "There is a freedom that can only be attributed to the lack of seizures," said Martha. "I can be by myself. I can focus in a way that I couldn’t before. I can practice without seizure. I can put on a metronome and not seize." Surprisingly, with much of her right temporal lobe gone, Martha’s memory scores actually improved and she could now memorize pieces. Her doctors theorized that eliminating the constant electrical interference produced by the damaged portion of the brain allowed the healthy portions to function without interference.
Such a substantial portion of brain was removed that many expected Martha to be more affected by the procedure. Her former Eastman teacher and mentor, Charles Castleman, credits her musical efforts with her surprising recovery. "The epileptic spikes that affected her were located in the part of the brain central to conceiving sound - never mind hearing and understanding music," said Castleman. "Her mother gave her a violin at an early age, when the brain can move impulses around. It would have been impossible for her to play, avoiding those spikes, without brain reorganization."
For years Martha balanced her love of music with the fear that it could cause a seizure - today she credits it with her recovery. Martha regularly travels, performs and speaks about her difficult journey. She is working on a book and resides in Pittsburgh with her husband Walter and two children.
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