Music by Mozart has been shown to have an antiepileptic effect on the brain and could potentially represent a treatment to prevent epileptic seizures, according to researchers headed by a team at the Epilepsy Centre, Hospital St. Anne and CEITEC Masaryk University, Brno. The studies, in epilepsy patients with implanted electrodes, demonstrated that listening to the 18th-century composer’s Sonata for Two Pianos K448, led to a reduction in epileptiform discharges (EDs) in the brain. These are electrical brain waves associated with epilepsy and can cause seizures or bursts of electrical activity that temporarily affect how the brain works. The researchers believe that the acoustic (physical) properties within the music are responsible for the effects of the music on reducing EDs.

Research lead Ivan Rektor, PhD, and colleagues, presented their results at the 7th Congress of the European Academy of Neurology (EAN). The studies are published in the European Journal of Neurology, in a paper titled, “Mozart effect in epilepsy: Why is Mozart better than Haydn? Acoustic qualities-based analysis of stereoelectroencephalography,” in which the authors commented, “To our knowledge, this is the first work that explores the effect of specific musical features (quantifying rhythm, dynamics, and timbre) on the number of EDs.”

The Mozart effect, which the authors described as “the enhancement of cognitive performance in spatial tasks while listening to Mozart’s Sonata for Two Pianos in D Major K 448 (K448),” has been reported multiple times. There also exists what the team suggests is a “complex” relationship between music and epilepsy. In rare, but well-described cases of musicogenic epilepsy, music may actually trigger a seizure. In contrast, it has been reported by multiple research teams that listening to Mozart’s K448 can reduce epileptiform discharges, measured by electrodes placed on the scalp, or scalp electroencephalography (EEG). One meta-analysis of 12 studies reported that 84% of patients demonstrated an overall reduction in the number of interictal EDs while listening to Mozart’s music. However, another review of literature concluded that the evidence for an anti-epileptic effect of music is only weak.

A significant proportion of EDs produced by the brain does not appear on scalp EEG, but can instead be recorded through intracerebral electrodes, Rektor and colleagues pointed out. For their stereoelectroencephalography (SEEG) study, the investigators used a stereotactic frame-based technique to implant intracerebral electrodes in 18 pharmacoresistant epilepsy patients (nine women and nine men), pre surgery. Each patient was fully informed and gave their written consent.

The study was designed to compare the effects on EDs of listening to either Mozart’s K448, or Haydn’s Symphony No. 94 (No94: Surprise Symphony). “We chose Haydn’s music as it represents a similar musical style from the same period,” the investigators wrote. “Works composed by Mozart and Haydn may have similar emotional effects.” In fact, the team noted, when comparing music in terms of the repetition of harmonies, Mozart’s music scored much higher than works by composers including Bach, Wagner, Beethoven, Chopin, and Liszt. “It was shown that K448 differs from music composed by other composers in terms of its higher repetition rate,” the team commented. Haydn’s music values were those that were scored second to Mozart’s. “We hypothesized that the similarity of the music of the two composers would reveal shared features as well as subtle differences that could explain their effects on EDs.”

As well as aiming to confirm the Mozart effect on EEG, the researchers wanted to analyze and compare the acoustic characteristics of Mozart’s and Haydn’s music, to confirm the hypothesis that the ED-reducing antiepileptic effect of music can be explained by the music’s acoustic properties.

Their study results showed that listening to Mozart’s Sonata for Two Pianos K448 led to a marked reduction in epileptiform discharges. “To our surprise, there were significant differences between the effects of listening to Mozart’s K448 and Haydn’s No 94,” commented Rektor. “Listening to Mozart led to a 32% decrease in EDs, but listening to Haydn’s No 94 caused a 45% increase.”

The findings indicated that, in fact, men and women responded differently to the two pieces of music. While the reduction of EDs with K448 was observed in both men and women, the team noted, listening to Haydn’s music led to suppressed epileptiform discharges only in women; in the men, there was an increase of epileptiform discharges. The acoustic properties, such as the rhythm, dynamics, and tone, showed that the acoustic features of music composition have a different effect on men and women.

The team wanted to explain the mechanism behind the “Mozart effect” in epilepsy. Researchers have previously hypothesized that the phenomenon is connected to the emotional effects of music, as dopamine (the main neurotransmitter of the brain’s reward system) is released when listening to music. However, there is no direct proof of the mechanism, and the authors further suggested that the effects of listening to music on epilepsy cannot be explained by the effect of dopamine released by the reward system. “We believe that the effect of listening to music on epilepsy cannot be explained by the effect of dopamine released by the reward system … Our patients were not music connoisseurs; they declared emotional indifference to the two compositions,” they wrote.

Rektor further acknowledged, “Our patients were not music connoisseurs and said they were emotionally indifferent to the two pieces of music … we found that the reduction in EDs was larger in the lateral temporal lobe, which is the part of the brain which participates in translating acoustic signals, rather than in the mesiotemporal limbic region, which plays an important role in the emotional response to music.” There was, therefore, no reason to believe that K448 evoked more pleasure than No. 94, he suggested. “We believe the physical ‘acoustic’ features of the Mozart music affect brain oscillations—or brain waves—which is responsible for reducing EDs.”

Epilepsy affects six million people in Europe, and 15 million Europeans have one seizure at some time in their lives. The team believes that the study’s collective findings could pave the way for the future development of individualized music therapies that might help to prevent and control epileptic seizures. They have called for more research into the effects of music on the brain. “Based on our research, we suggest studying the use of musical pieces with well-defined acoustic properties as a non-invasive method to reduce epileptic activity in patients with epilepsy,” concluded Rektor.

The authors pointed out that further research—and in particular long-term randomized controlled studies on the therapeutic effects of listening to music in epilepsy—will be required. “A clinical effect, that is, the decrease of frequency of epileptic seizures, has been reported, mostly on small cohorts,” they acknowledged. “The evidence for the antiepileptic effect of music has been summarized as limited and low quality.” Nevertheless, they concluded, “Based on our findings of musical features leading to an antiepileptic effect (ED-reducing effect) in EEG, we believe that it could be possible to find optimal features on an individual level and consequently optimize the music therapy of epilepsy. In any case, musical features should be considered in future research on music and epilepsy.”

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