MEDICINE AND THE ARTS
and language with frequent reference to Broca and Wernicke . The only exception stuck in my memory is the discussion by one of our professors ( who was also a pianist ) about the incredible feat by Shebalin , a Russian composer , who wrote his Symphony No . 5 while totally language-impaired from two episodes of stroke . Publication of Music and the Brain in 1977 by Drs . Macdonald Critchley and Ronald Henson 2 kindled considerable interest in the topic leading to further research in “ neuromusicology .” Dr . Critchley 3 is also credited with the use of the term Musicogenic epilepsy for a form of reflex epilepsy in which seizures are provoked by certain music , vocal or instrumental . One of Critchley ’ s famous cases was that of a music critic who became progressively more and more sensitive to music , developing frequent seizures ; he became “ musicophobic ” and had to leave the profession . The seizure focus in musicogenic epilepsy is often on the right temporal lobe and may cause partial complex or rarely generalized tonic clonic seizures . These patients often respond to antiepileptic medications , but if resistant , are candidates for ablation of seizure focus .
My interest in music and the brain was triggered by a patient I saw in the 70s . A middle aged teacher was concerned about episodes in which she would suddenly hear the beginning of an old song ( a Bollywood song she used to sing as a kid ) then soon become unaware of what was going on around her for a minute or so . Initially she enjoyed the music but became concerned as the episodes occurred with increasing frequency . The pattern suggested partial complex seizure with musical aura . An EEG showed epileptiform activity in the right mid temporal area . A carotid angiogram ( it was pre-CT / MRI era ) showed a sphenoid wing meningioma . The tumor was removed , and she was seizure-free after a year of anti-epileptic drug therapy .
There are several rare , but fascinating disorders centered around music . Musical tinnitus ( musical ear syndrome ) is one where the patient hears music continuously , which may become quite annoying . It may sometimes occur in patients with significant hearing loss ; the prevailing theory is that loss of afferent input from auditory pathways leads eventually to spontaneous activation of networks involved in music perception leading to the musical hallucinations . This is like the complex visual hallucinations known to occur in the blind ( Charles Bonnet syndrome ). Another unique condition is Williams syndrome , a neurodevelopmental disorder caused by deletion of 26-28 genes on chromosome 7 , in which the patients exhibit a high musical talent despite considerable cognitive issues . Oliver Sacks in his famous book Musicophilia 4 provides interesting tidbits about this unique syndrome .
Sonata for Two Pianos in D major ( K . 448 ) composed by Wolfgang Amadeus Mozart in 1781 was in the limelight in the 1990s . Many of you may remember the hubbub caused by news media exaggerating / misinterpreting data from research by Francis Rauscher in 1993 . 5 That study looked at the effect of listening to Mozart ’ s piano sonata for 10 minutes , versus 10 minutes of silence , versus listening to a person talking for 10 minutes . It was found that students who had listened to piano scored significantly higher on spatial temporal tasks . Media hype started with banners like “ Mozart makes you smart .” Then came the myth that children who listen to classical music from a young age will get better scores in examinations . The governor of Georgia decided to distribute a free classical music CD to every baby born ; Tennessee then did the same . Although the excitement died down , there is growing evidence that Mozart ’ s Sonata for Two Pianos in D Major ( K . 448 ) does indeed reduce seizure activity . A study by Quon and his colleagues , 6 reported in a recent publication , recommends trial of the Mozart effect in patients with refractory epilepsy .
A more common music related disorder that I have seen is Musician ’ s Dystonia , which is a task-specific dystonia like writers ’ cramp . It is believed to be a disorder of brain plasticity , an exaggeration of brain changes that are required to achieve advanced musical skills . 7
Any discussion on music and brain cannot be complete without mentioning music therapy . Music is believed to activate brain networks involved in speech , motor and cognitive centers and facilitate neuroplasticity . While the list of conditions that may benefit from music therapy is quite long , there has been considerable interest recently in its potential to benefit patients with Alzheimer ’ s disease 8 and non-fluent aphasia . 9
Let me conclude with a quote from Daniel Levitin , the author of the fabulous book , 10 This Is Your Brain On Music : The Science of a Human Obsession .
“ Music may be the activity that prepared our pre-human ancestors for speech communication and for the very cognitive , representational flexibility necessary to become humans .”
References
1
Peretz I et al . Congenital amusia : a disorder of fine-grained pitch discrimination . Neuron 2002 ; 33 : 195-191
2
Music and the Brain , ( Eds ) M . Critchley and R . A . Henson , 1977 . William Heinemann , London
3
Critchley M . Musicogenic epilepsy . Brain 1937 ; 60 : 1-27
4
Musicophilia by Oliver Sacks 2008 Vintage NY
5
Rauscher EH , Shaw GL , Ky KN . Music and spatial task performance . Nature 1993 ; 365 , 611
6
Quon RJ et al . Musical components important for Mozart K448 effect in epilepsy sci rep 2021 ; 11 https :// doi . org / 10.1038 / s41598-021-95922-7
7
Sussman J . Musician ’ s dystonia . http :// dx . doi . org / 10.1136 / practneurol-2015-001148
8
Leggieri M et al . Music intervention approaches for Alzheimer ’ s disease . Front Neurosc . 2019 ; 13:132
9
Racette A et al . Making non-fluent aphasics speak : sing along ! Brain ; 2006 ; 129 ( 10 ): 2571-2584
10
This is Your Brain on Music : The Science of a Human Obsession by Daniel J . Levitin 2016 Dutton
Dr . Iyer practices at the Neurodiagnostic Center of Louisville and is a retired professor of neurology at the University of Louisville School of Medicine .
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