Mozart and epilepsy: the rhythm beats on

I can’t seem to get away from the theme of Mozart and epilepsy. When I first looked at this, in a blog post titled Mozart and seizures? The links between epilepsy and music, I took the topic rather lightly, more a subscript than a headline you may say. But I have since learnt to take the links between epilepsy and music more seriously. 

By Barbara KrafftThe Bridgeman Art Library, Object 574471, Public Domain, Link

The major trigger for my ‘road to Damascus’ conversion is a 2018 paper titled Study of the Mozart effect in children with epileptic electroencephalograms, published in the journal Seizure. The paper was an eye-opener because it gave a very helpful comprehensive context to the broader beneficial effect of music…not just in epilepsy, but in other neurological disorders such as Parkinson’s disease, dementia and sleep disorders. The authors, Elyza Grylls and colleagues, started on the established premise that Mozart’s music has a beneficial effect on epilepsy. What they wanted to know was if other forms of music have a similar settling effect on epilepsy, or if only Mozart’s music carries the magic touch. The authors therefore played Mozart’s Sonata for two pianos in D major (K448) to 40 children with epilepsy who were undergoing an EEG (electroencephalogram, or electrical brain wave test). They then compared this with the effect of playing other types of music. Remarkably, they found that only Mozart’s Sonata led to a significant reduction in EEG epileptic discharges.

Public Domain, Link

The authors concluded that there was indeed an anti-epileptic effect of Mozart’s music, the so-called  ‘Mozart therapy’. But what is so special about K448? They speculate that it has to do with the structure of Mozart’s music, containing as it does, long periodicities. Interestingly, the music of Yanni, which is similarly structured, has somewhat a similar effect on brain wave activity. On the contrary, and sorry to Beethoven fans, Fur Elise doesn’t have this effect.

By W.J. Baker (held the expired copyright on the photograph) – Library of Congress[1]Contrairement à une erreur fréquemment répandue le buste a été réalisé par Hugo Hagen, non pas à partir du masque mortuaire mais, comme de nombreux autres, d’après le masque réalisé en 1812 par Franz Klein pour un buste qu’il devait réaliser ensuite., Public Domain, Link
So what does the structure of Mozart’s music do to the brain? One suggestion is that Mozart’s music enhances the body’s parasympathetic drive; this reduces the heart rate, and thereby inhibits the brain’s propensity to epileptic seizures. The suppression of this parasympathetic drive is of course the theory behind using vagus nerve stimulation (VNS) to treat drug-resistant epilepsy. For more on VNS, see my previous blog, Vagus nerve stimulation: from neurology and beyond!

By Bionerd – MRI at Charite Mitte, Berlin (used with permission), CC BY 3.0, Link

You have surely wondered by now whether K448 is the only one of Mozart’s compositions to have an anti-epileptic effect. It doesn’t matter if you haven’t, because the authors of another interesting paper have. They titled their study, published in 2018, Mozart’s music in children with drug-refractory epileptic encephalopathies: comparison of two protocols. Published in the journal Epilepsy and Behaviour, the authors, Giangennaro Coppola and colleagues, compared the effect of K448 with a set of his other compositions. Intriguingly they found that the composition set actually had a greater effect in epilepsy than K448…by a wide margin of 70% to 20%! Furthermore, the set was better tolerated by the children; they were less irritable and had a better nighttime sleep quality.   

https://www.publicdomainpictures.net/en/view-image.php?image=76907&picture=dog-amp-child-painting

So, is it all rosy in the garden of music and the brain? No, it’s not! As every rose grows on a thorny tree, so do some forms of music trigger epileptic seizures. This so-called musicogenic epilepsy is well-recognised, and two recent culprits are the music of Sean Paul, discussed in the journal Scientific American , and the music of Ne Yo, explored by NME. Therefore you should craft your playlist wisely.

By CLASSICNEYOOwn work, CC BY-SA 4.0, Link

So, is it time for neurologists to start prescribing music?

Or is it too much of a double-edged sword?

Music is #SimplyIrresistible. Luca Florio on Flickr. https://www.flickr.com/photos/elle_florio/29516744480

Phantoms in the Brain

Phantoms in the Brain Authors: V. S. Ramachandran and Sandra Blakeslee Synopsis The author of this book, one the leading figures in neuroscience, unapologetically declared that his intention was to write ‘a popular book on the brain’. To accomplish this goal, he recounts seemingly endless ‘true-life stories‘ of fascinating neurological disorders (page xiii). Like a […]

via Phantoms in the Brain — The Doctors Bookshelf

Do statins delay motor progression of Huntington’s disease?

Statin use and delayed onset of Huntington’s disease. Schultz JL, Nopoulos PC, Killoran A, Kamholz JA. Mov Disord 2019; 34:281-285. Abstract BACKGROUND: There is evidence to suggest that 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) may be beneficial in Huntington’s disease (HD). OBJECTIVE: This study aimed to determine if statin use was associated with delayed motor diagnosis in participants with premotor HD. METHODS: Among premotor […]

via Do statins delay motor progression of Huntington’s disease? — Neurochecklists Blog

A Portrait of the Brain

A Portrait of the Brain Author: Adam Zeman Synopsis How do you sketch a vivid profile of the most perplexing organ in the body? How do you portray the intricate workings of what is, ‘by a very long way, the most complex entity we have yet encountered in the universe‘? (page 36). The author of […]

via A Portrait of the Brain — The Doctors Bookshelf

Clipping the wings of cerebral aneurysms: is the pendulum swinging back?

This is a follow up to my previous blog post, What should we really know about cerebral aneurysms? In that post, I discussed the nature and presentations of cerebral aneurysms. In this post I will look at the two major treatments for cerebral aneurysms, exploring their pros and cons, and looking at some emerging challenges to the conventional wisdom. 

By Tiago Etiene QueirozOwn work, CC BY-SA 3.0, Link

The first question to answer regarding treatment of aneurysms is whether they need any treatment at all. In other words, are they best left well alone? In principle, aneurysms that have ruptured require treatment, irrespective of their size. On the other hand, aneurysms that are discovered incidentally, before they rupture, may not need surgical treatment unless they are large (usually 7mm or more in diameter), or they are associated with high-risk features/locations. Low-risk aneurysms that do not require treatment however need long-term surveillance with intermittent brain imaging. To limit the growth of such aneurysms, people harbouring them are advised to stop smoking, and if they have hypertension, to ensure that this is well-controlled.

By Professor Dr. O. Bollinger. – LEHMANN’S MEDICIN. HAND ATLANTEN Atlas und Grundrissder PATHOLOGISCHENANATOMIE 1901, Public Domain, Link

There are two treatment approaches to ruptured aneurysms and high-risk unruptured aneurysms. The first is invasive and neurosurgical; the cranium is opened, the aneurysm located, and a surgical clip is put around its neck, sequestering it from its parent vessel. In this way, with its wing literally clipped, the aneurysm is disarmed, its potential for growth and rupture severely restricted. 

By Roberto Stefini – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=47226273

The other procedure, younger and safer than clipping, is endovascular coiling or coil embolisation. This procedure, performed by an interventional neuroradiologist, involves tunnelling a fine wire or coil through blood vessels until it reaches the aneurysm. The aneurysm space is then filled up with the coil until it is totally obliterated. Unable to fill up with blood or expand, the aneurysm is rendered impotent. Both coiling and clipping however carry a small failure risk, resulting in aneurysm recurrence or re-rupture.

By 77giallo77 – Own work, CC BY-SA 4.0, Link

This is the conventional wisdom of cerebral aneurysm treatment. But there are advocates out there who are pushing the case for clipping over coiling. One reason they put forward is the emerging observation that clipping results in better recovery of function of the third cranial or oculomotor nerve. The oculomotor nerve is critical to the movement of the eye and eyelid, and it is vulnerable to compression by the posterior communicating artery (PCOM) aneurysm. A compressed third cranial nerve results in a droopy eyelid (ptosis) and double vision (diplopia); recovery of function of the oculomotor nerve is therefore an important goal in the treatment of aneurysms.

Автор: Patrick J. Lynch, medical illustrator – Patrick J. Lynch, medical illustrator, CC BY 2.5, Посилання

There are now at least four systematic reviews and/or meta-analyses that show that recovery of the oculomotor nerve function is better achieved by clipping than by coiling. These are:

Another meta-analysis, titled Clinical outcome after surgical clipping or endovascular coiling for cerebral aneurysms, goes further to argue that clipping results in better chances of survival and independent living than coiling. 

By HellerhoffOwn work, CC BY-SA 3.0, Link

These may be the last-gasp attempts of clippers to have one up over coilers, but the consensus still remains dominantly in favour of endovascular coiling. We however need to keep a close eye on this pendulum-it may just swing back unexpectedly.

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Why not check out these related blog posts:

How does aspirin influence the rupture risk of cerebral aneurysms?

Is the growth of cerebral aneurysms predictable?

Reaching Down the Rabbit Hole 

Reaching Down the Rabbit Hole Authors: Allan H. Ropper and Brian David Burrell Synopsis This book is about the day-to-day practice of one of the leading neurologists in the world. It explores his challenging work in one of the most prestigious of hospitals, the Brigham and Women’s Hospital– ‘a place where the strangest and challenging […]

via Reaching Down the Rabbit Hole  — The Doctors Bookshelf