Listening to Mozart has a notable impact on seizure reduction in patients with epilepsy — and now researchers believe they know why, new research suggests.
Investigators found that the acoustic characteristics of Mozart’s Sonata for Two Pianos in D Major (K448) suppresses brain activity in patients with epilepsy while a piece by the 18th century classical composer Franz Joseph Haydn did not have this effect.
Listening to this Mozart sonata and perhaps other musical pieces may eventually become a treatment for preventing epileptic seizures, said study investigator Ivan Rektor, MD, CSc, Epilepsy Centre at the Hospital St Anne and professor at the Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
“This research into the impact of listening to music could lead to the development of a music-related type of palliative neurostimulation therapy,” Rektor told Medscape Medical News.
The findings were presented at the virtual Congress of the European Academy of Neurology (EAN) 2021 and published online in the European Journal of Neurology.
Epilepsy affects 6 million people in Europe. Furthermore, estimates show that about 15 million Europeans have had at least one seizure at some time in their lives. In addition, about 30% of patients with epilepsy are not adequately treated with antiseizure medications.
Researchers have been studying the impact of Mozart’s music on brain-wave activity since the 1990s. Various studies report a reduction in epileptiform discharges in patients with epileptic seizures, coma, and refractory nonconvulsive status.
A 2012 meta-analysis of 12 publications involving patients with epilepsy showed an overall reduction in the number of interictal epileptic discharges (IEDs) or abnormal electrical brain waves in 84% of participants who listened to Mozart’s music. A more recent meta-analysis also showed a significant reduction in epileptic seizures and IEDs.
As previously reported by Medscape Medical News, American researchers also found Mozart’s music regulated abnormal interictal epileptiform activity (IEA), especially in those with a high baseline rate of interictal spikes.
However, the methodological quality of some of this research “has been limited,” Rektor noted. He added that use of music therapy in clinical practice is still considered “controversial.”
The new study included 18 treatment-resistant patients with epilepsy (50% men) who ranged in age from 19 to 55 years. Participants had intracerebral electrodes implanted in the brain before undergoing surgery.
Of the total study population, 15 had temporal lobe epilepsy and three had extratemporal epilepsy. Eleven were affected on the left side, six on the right side, and one bi-temporally. Duration of epilepsy ranged from 8 to 40 years.
Patients listened to the Mozart piece intermittently on one day and to Haydn’s “Surprise” Symphony No 94 the next day. Researchers counted the number of ED discharges before, during, and after the patients listened to the music.
Results showed that exposure to the Mozart piece was associated with a 32% reduction in IEDs, from 28 EDs pre-exposure to 19 during exposure. However, IEDs rose to 21 post-exposure.
Overall, the Haydn piece was associated with an increase in IEDs, from 23 pre-exposure to 26 during and post-exposure.
“We saw a clear decrease in epileptic spikes while listening and after listening to Mozart, while there was an increase in spikes while listening to Haydn,” Rektor said.
He added that all 18 patients responded “more or less” to the music and that the results were statistically significant.
Rektor noted that the investigators were not surprised by the Mozart effect, but were somewhat taken aback by the opposite effect from listening to Haydn.
The impact differed between men and women. The Mozart piece had a larger effect on women. In addition, the Haydn piece led to a decrease in spikes in women but led to “a clear” increase in men, Rektor reported.
In an effort to explore why the two classical pieces had such different effects, the researchers examined the acoustic properties.
They worked with acoustic engineers to examine three musical properties that might influence the number of spikes: rhythm (tempo or beats per minute), dynamics (energy), and timbre (how harsh or unpleasant, how noisy, and how many “high-frequency” parts the music has).
“We observed that K448 [Mozart’s piece] has a more harmonic spectrum and its spectral content doesn’t change quickly, which probably has a positive effect on epilepsy patients,” said Rektor.
Specific features of the music had a slightly different effect on men and women. Men were more sensitive to dissonance and high-frequency parts while women were more sensitive to energy.
A New Theory
Researchers previously hypothesised that the Mozart effect in epilepsy was connected to the emotional impact of music. The neurotransmitter dopamine, which plays a role in the brain’s reward system, is released when listening to music.
However, the new research seems to challenge that theory. The majority of the participants did not express a strong preference for classical music.
“We believe emotions didn’t play an important role in these patients,” Rektor said, adding that the impact was instead mostly related to acoustic signals.
The team also found that the reduction in IEDs was larger in the lateral temporal lobe, the part of the brain involved in translating acoustic signals, rather than in the mesiotemporal limbic region, which plays an important role in the emotional response to music.
Comparing men with women, there’s an “overlap” of brain activation in most brain areas. However, some areas are more activated in men and others in women, said Rektor.
While the Mozart Sonata for two pianos in D Major has become the “gold standard” in this type of research, Rektor said “it’s very probable” that other classical compositions with similar acoustic properties have the same effect in epilepsy.
The investigators are testing other musical pieces, both classical and nonclassical. The ultimate aim is to develop individualized musical patterns based on these acoustic features.
“If it works, we would like to use it as a noninvasive neurostimulation method,” Rektor said.
Commenting on the study, session chair Marte Bjørk, MD, PhD, associate professor, Department of Clinical Medicine, University of Bergen, Bergen, Norway, called it “inspiring.”
She noted that she recently had a patient whose temporal lobe seizures were consistently triggered by music played on a children’s TV program.
“So I have no doubt that music can be important for some patients,” Bjørk said.
She questioned whether factors other than gender may predict response to music.
The study authors have disclosed no relevant financial relationships.
Congress of the European Academy of Neurology (EAN) 2021: Session EPR-145. Presented June 19, 2021.
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