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In Reply: In response to Dr Gordon, there is evidence that van Gogh had several disorders, including major depression, epilepsy, absinthe toxicity, and Meniere disease.^1-2 These are not mutually exclusive diagnoses.

Isolated tinnitus or vertigo as the symptom of a seizure focus in or near auditory cortex is indeed rare, but this symptom can be evoked by electrical stimulation in humans. This patient's syndrome, however, did not involve isolated tinnitus or vertigo. Rather, he reported paroxysmal and brief episodes of vertigo combined with distortion of limb size, déjà vu, and other symptoms characteristic of a temporal lobe seizure focus. This combination of symptoms, as well as the time course of symptoms and response to antiepileptic drugs, would be extremely atypical for peripheral eighth nerve disorders.

Orrin Devinsky, MD
New York University Epilepsy Center
New York, NY

1. Bryant JE. Genius and Epilepsy. Concord, Mass: Ye Old Depot Press; 1953. 2. Blumer D. The illness of Vincent van Gogh. Am J Psychiatry. 2002;159:519-526. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:2407.

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