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

Vagus nerve stimulation: from neurology and beyond!

The vagus nerve is one of 12 pairs of nerves that come off the lower part of the brain called the brainstem. It is the tenth in line and therefore also called the tenth cranial (or X) nerve.

 

By Brain_human_normal_inferior_view_with_labels_en.svg: *Brain_human_normal_inferior_view.svg: Patrick J. Lynch, medical illustrator derivative work: Beao derivative work: Dwstultz [CC BY 2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons
By Brain_human_normal_inferior_view_with_labels_en.svg: *Brain_human_normal_inferior_view.svg: Patrick J. Lynch, medical illustrator derivative work: Beao derivative work: Dwstultz [CC BY 2.5 (http://creativecommons.org/licenses/by/2.5)%5D, via Wikimedia Commons

It is an interesting nerve for various reasons. Unlike other cranial nerves, it travels way beyond the head and neck. It has a very long course through the neck to the chest and abdomen. Furthermore it regulates a wide variety of organ functions such as heart, respiratory and gut activities. An important branch of the vagus nerve is the recurrent laryngeal nerve which innervates the larynx (voice box). 

Due to a quirk of the embryonic development of the aorta, this nerve gets pulled down into the chest before it makes a U-turn back to the neck. It is therefore easily damaged in operations of the neck or chest, and therefore the bane of surgeons.

 

By Truth-seeker2004 (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
By Truth-seeker2004 (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

Scientists have recognised this characteristic feature of the vagus nerve and have tried to manipulate it for therapeutic reasons. The most well-recognised is the stimulation of the vagus nerve to control epileptic seizures. This vagus nerve stimulation (VNS) requires implanting a stimulator under the skin on the chest, and this is connected to the vagus nerve with wires. Somehow or the other, this stimulation modulates seizures. The Epilepsy Society has detailed information on the technical aspects of VNS, and below is a video showing how VNS works.

The American Academy of Neurology guidelines on VNS, published in the journal Neurology, help Neurologists decide when to use VNS. Below are the main indications for VNS in epilepsy:

  • Refractory partial onset seizures in adults >12 years not suitable for surgery
  • Partial or generalised seizures in children
  • Lennox-Gastaut syndrome (LGS)
  • Mood improvement in adult epilepsy

VNS has other neurological indications  which are coming online and top of these is Cluster headache. And now, just off the press, is a possible role for VNS in migraine.

Headache by openDemocracy on Flikr. https://www.flickr.com/photos/opendemocracy/1482020719
Headache by openDemocracy on Flikr. https://www.flickr.com/photos/opendemocracy/1482020719

 

There are however several non-neurological diseases that may benefit from VNS including arthritis, diabetes, hiccups and heart failure. Science News explores these indications further in an article interestingly titled Viva Vagus: Wandering Nerve Could Lead to Range of TherapiesLike opening a can of worms, VNS may extend it’s tentacles far and wide; imagine for example that there is a study looking at the benefit of VNS in bulimia.

"Bulimiav bvjkfhdnijf" by Merlymeleanrossana - Treball propi. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Bulimiav_bvjkfhdnijf.jpg#/media/File:Bulimiav_bvjkfhdnijf.jpg
“Bulimiav bvjkfhdnijf” by Merlymeleanrossana – Treball propi. Licensed under CC BY-SA 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:Bulimiav_bvjkfhdnijf.jpg#/media/File:Bulimiav_bvjkfhdnijf.jpg

 

Whatever next?

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