Music training is neuroprotective for verbal cognition in focal epilepsy

Therapeutic effect of tempo in Mozart's "Sonata for two pianos" (K. 448) in patients with epilepsy: An electroencephalographic study

BACKGROUND

Mozart's "Sonata for two pianos" (Köchel listing 448) has proven effective as music therapy for patients with epilepsy, but little is understood about the mechanism of which feature in it impacted therapeutic effect. This study explored whether tempo in that piece is important for its therapeutic effect.

METHODS

We measured the effects of tempo in Mozart's sonata on clinical and electroencephalographic parameters of 147 patients with epilepsy who listened to the music at slow, original, or accelerated speed. As a control, patients listened to Haydn's Symphony no. 94 at original speed.

RESULTS

Listening to Mozart's piece at original speed significantly reduced the number of interictal epileptic discharges. It decreased beta power in the frontal, parietal, and occipital regions, suggesting increased auditory attention and reduced visual attention. It also decreased functional connectivity among frontal, parietal, temporal, and occipital brain regions, also suggesting increased auditory attention and reduced visual attention. No such effects were observed after patients listened to the slow or fast version of Mozart's piece, or to Haydn's symphony at normal speed.

CONCLUSIONS

These results suggest that Mozart's "Sonata for two pianos" may exert therapeutic effects by regulating attention when played at its original tempo, but not slower or faster. These findings may help guide the design and optimization of music therapy against epilepsy.

Quality standards and recommendations for research in music and neuroplasticity

Research on how music influences brain plasticity has gained momentum in recent years. Considering, however, the nonuniform methodological standards implemented, the findings end up being nonreplicable and less generalizable. To address the need for a standardized baseline of research quality, we gathered all the studies in the music and neuroplasticity field in 2019 and appraised their methodological rigor systematically and critically. The aim was to provide a preliminary and, at the minimum, acceptable quality threshold-and, ipso facto, suggested recommendations-whereupon further discussion and development may take place. Quality appraisal was performed on 89 articles by three independent raters, following a standardized scoring system. The raters' scoring was cross-referenced following an inter-rater reliability measure, and further studied by performing multiple ratings comparisons and matrix analyses. The results for methodological quality were at a quite good level (quantitative articles: mean = 0.737, SD = 0.084; qualitative articles: mean = 0.677, SD = 0.144), following a moderate but statistically significant level of agreement between the raters (W = 0.44, χ² = 117.249, p = 0.020). We conclude that the standards for implementation and reporting are of high quality; however, certain improvements are needed to reach the stringent levels presumed for such an influential interdisciplinary scientific field.

The cognitive functions and seizure outcomes of patients with low-grade epilepsy-associated neuroepithelial tumors

PURPOSE

The aim of the study was to evaluate the cognitive functions and seizure outcomes of patients with low-grade epilepsy-associated neuroepithelial tumors (LEATs).

METHODS

We retrospectively reviewed the clinical data of patients who underwent preoperative neuropsychological evaluations and subsequent epilepsy surgery for LEATs. The neuropsychological results of full-scaled intelligence quotient (FSIQ) and full-scaled memory quotient (FSMQ) were analyzed, as well as the postoperative seizure outcomes.

RESULTS

Of the 138 patients included in the study, 59 patients (40.4%) were female and 47 (36.6%) patients were children. Preoperatively, 138 patients received FSIQ assessments and 30 patients (21.7%) had an intellectual deficit (FSIQ < 80 scores); 124 patients received FSMQ assessments and 32 patients (25.8%) had a memory deficit (FSMQ < 80 scores). Younger age at seizure onset (OR 0.93; P = 0.035) and discordant ictal electroencephalography (EEG) findings (OR 5.26; P = 0.001) were found to predict intellectual deficits, while abnormal hippocampus (OR 2.36; P = 0.051) as well as discordant ictal EEG findings (OR 4.03; P = 0.007) tended to cause memory deficits. During postoperative follow-up, 123 patients (90.7%) were followed up at least 12 months, and among them, 105 patients (85.4%) got seizure-free (Engel class I), while 18 patients (14.6%) were not (Engel class II-IV); longer duration of epilepsy (OR 1.01; P < 0.001) and discordant interictal EEG findings (OR 5.91; P = 0.005) were found to be related to poor seizure outcomes in patients with LEATs.

CONCLUSION

Cognitive deficits commonly occur in patients with LEATs, especially in patients with early or childhood seizures. Early surgical intervention, however, could prevent most of patients from repeated seizure onsets and thus cognitive impairments.

Musical Auditory Alpha Wave Neurofeedback: Validation and Cognitive Perspectives

Neurofeedback through visual, auditory, or tactile sensations improves cognitive functions and alters the activities of daily living. However, some people, such as children and the elderly, have difficulty concentrating on neurofeedback for a long time. Constant stressless neurofeedback for a long time may be achieved with auditory neurofeedback using music. The primary purpose of this study was to clarify whether music-based auditory neurofeedback increases the power of the alpha wave in healthy subjects. During neurofeedback, white noise was superimposed on classical music, with the noise level inversely correlating with normalized alpha wave power. This was a single-blind, randomized control crossover trial in which 10 healthy subjects underwent, in an assigned order, normal and random feedback (NF and RF), either of which was at least 4 weeks long. Cognitive functions were evaluated before, between, and after each neurofeedback period. The secondary purpose was to assess neurofeedback-induced changes in cognitive functions. A crossover analysis showed that normalized alpha-power was significantly higher in NF than in RF; therefore, music-based auditory neurofeedback facilitated alpha wave induction. A composite category-based analysis of cognitive functions revealed greater improvements in short-term memory in subjects whose alpha-power increased in response to NF. The present study employed a long period of auditory alpha neurofeedback and achieved successful alpha wave induction and subsequent improvements in cognitive functions. Although this was a pilot study that validated a music-based alpha neurofeedback system for healthy subjects, the results obtained are encouraging for those with difficulty in concentrating on conventional alpha neurofeedback.

Trial registration: 2018077NI, date of registration: 2018/11/27

Music processing deficits in Landau-Kleffner syndrome: Four case studies in adulthood

Verbal-auditory agnosia and aphasia are the most prominent symptoms in Landau-Kleffner syndrome (LKS), a childhood epilepsy that can have sustained long-term effects on language processing. The present study provides the first objective investigation of music perception skills in four adult patients with a diagnosis of LKS during childhood, covering the spectrum of severity of the syndrome from mild to severe. Pitch discrimination, short-term memory for melodic, rhythmic and verbal information, as well as emotion recognition in music and speech prosody were assessed with listening tests, and subjective attitude to music with a questionnaire. We observed amusia in 3 out of 4 patients, with elevated pitch discrimination thresholds and poor short-term memory for melody and rhythm. The two patients with the most severe LKS had impairments in music and prosody emotion recognition, but normal perception of emotional intensity of music. Overall, performance in music processing tasks was proportional to the severity of the syndrome. Nonetheless, the four patients reported that they enjoyed music, felt musical emotions, and used music in their daily life. These new data support the hypothesis that, beyond verbal impairments, cerebral networks involved in sound processing and encoding are deeply altered by the epileptic activity in LKS, well after electrophysiological normalization.