Michael Jackson, Voodoo death and Neurology

Michael Jackson and Neurology?

While these may seem to be strange bedfellows, there are actually a lot of neurological issues involved in his life and death.

He certainly was the King of Pop and we know that entertainment may lead to sleep disorders. Common reasons for insomnia (even in patients with neurological diagnoses), include poor sleep hygiene and obstructive sleep apnea (OSA). Thriller certainly leads to fright, and while it changed the face of music videos (MTV), it's gruesome depiction of zombie-like characters is reminiscent of people with lobotomies and frontal lobe dysfunction. It could be argued that Michal Jackson, himself, sufferred from executive dysfunction.

Another aspect of our recent loss is the outpouring of grieving over his death. Grief is a natural step in all of our lives, and is split into five sequential stages by Elisabeth Kubler-Ross (1959): Denial, Anger, Bargaining, Depression, and Acceptance.

Being diagnosed with a lifetime (not lifelong) neurological diagnosis (not disease) often leads to these stages of grief. It is important for the patient and loved ones to work through these stages in conjunction with their primary care physician, neurologist and psychologist/psychiatrist. For those who are religious, priests, pastors, imams and rabbis may play an important role in this process.


But now the heart of the neurological connection between Michael Jackson's untimely death and neurology: "Voodoo" death.

While normally the heart and other organs work on their own (think about heart cells in a petri dish), we all know that the brain is central to all that we do as human beings (brain death is considered death). This means that sometimes the nervous system reacts to an extreme stressor and cause irregularities, such as cardiac irregularities ("cerebral" T waves and contraction band necrosis).

We now suspect that the insula (http://upload.wikimedia.org/wikipedia/commons/2/20/Gray717.png) plays an important role in regulating the heart (coined the "cardunculus," like the homunculus). Patients with left insular strokes, as opposed to non-insular had a worse outcome in the article by Laowattana et al. (S. Laowattana, S. L. Zeger, J.A.C. Lima, et al. Left insular stroke is associated with adverse cardiac outcome Neurology 2006;66:477-483).

Dr. Marty Samuels, Chairman, Department of Neurology Brigham and Women's Hospital and I have discussed the deaths after the Red Socks defeated the Yankees in the 2004 World Series, where super fans had said things like "I will be able to die once the Red Socks win the World Series." Once the Red Socks did finally break the Curse of the Bambino, people actually died of extreme emotion.

Death also occurs after extreme stress or fright -- see: http://www.boston.com/news/globe/magazine/articles/2006/08/06/scared_to_death/


So what does this have to do with Jacko?

He was about to (hopefully) end many of his financial woes through a three-year plan with AEG worth $400 million (the UK economy was also going to be bailed-out, to the tune of $1 billion, with the stimulus by his concerts -- perhaps there is a hidden lesson for Bernacke, Geithner and Obama). For a frail international icon, these financial boosts were clearly a source of extreme emotion, and may have led to his death.

With such a turbulent and controversial life, may he rest in peace.


--
Dr. Daniel Kantor, MD BSE
Medical Director
Neurologique