Music as Healing: Could it Work for Epilepsy?
Across Indigenous cultures, music (and cultural arts as a whole) plays a significant role in healing (France, 2020). Music is understood as an expression of the spirit and in turn as a form of medicine; the vibrations of singing and drumming are what encourage healing (p. 417). These community-focused practices were not established in clinical settings, which should remind us that the boundaries of science are sometimes too rigid. Likewise, those with ADHD often independently identify music as constructive to their working and learning environments (Ball, 2023), but why does it help? Medical treatments can come about under the circumstances of “We don’t know why it works, but it does” and prompt further research. Researchers have started to explore music’s potential therapeutic qualities with the hopes of establishing empirical proof.
Music and Epilepsy: A Critical Review
In “Music and epilepsy: A critical review” (2012), Melissa Maguire outlines why music has been of interest to researchers and contextualizes it for epilepsy. To begin, she explains the inner workings of the brain – describing how pitch, melodies, chords, and so on are processed (p. 948). This provides crucial context for how various stimuli affect different areas of the brain. She establishes that research on the relationship between music and the brain began at least as early as the 19th century when German researchers identified the impacts of brain damage on musical functioning (p. 948).
As always, epilepsy is complex enough that no one conclusion can be drawn about potential therapeutic treatments. Immediately at the beginning of the paper, Maguire points to the frustrating dichotomy of music as both a trigger and an aid (p. 947) – the former akin to the experiences of those with photosensitive epilepsy. Musicogenic epilepsy – considered relatively rare (p. 949) – is explicitly triggered by music. Consistency is foreign to this diagnosis: seizures are generally induced by listening to music, but can even occur when playing, thinking, or dreaming of music. Likewise, their triggers are not limited to one type of music, instrument, composer, tone, or emotional quality (pp. 949-950). The “hyperexcitable” nature of some parts of our brain may be the root cause, Maguire explains (pp. 948, 950, 952). Most therapies avoid musical triggers or more creatively, attempt to “usurp” a seizure using either innocuous or noxious music (p. 950). In the conclusion of the paper, Maguire adds that musicogenic epilepsy may go underdiagnosed as sound triggers are not a routine element in seizure provocation screenings (p. 958).
Turning to temporal lobe epilepsy, Maguire describes the musical ictal phenomenon. This is categorized into positive phenomena (as with auditory hallucinations, musicophilia, ictal singing or whistling) or negative (as with aprosody or amusia; pp. 950-951). These are all generally rare phenomena, with few documented cases each. Auditory hallucinations are also associated with temporal lobe epilepsy, and can range from simple noises to more complex melodies. Some patients reported hearing voices, but the same regions of the brain were activated (p. 951).
Having established the complexities of the relationship between music and epilepsy, Maguire opens the therapeutic section of her paper by pointing to research in other fields (Parkinson’s, dementia, ADHD, e.g.). Scientists in these fields favour the “Mozart Effect”, where the Mozart Sonata K.448 appears to offer cognitive benefits. She is careful to note that the theory has been subject to skepticism, but it seems to be that most neuroscientists are concerned about control processes – not just the theory entirely (p. 952). That said, she writes: “The evidence for music as an anticonvulsant […] is limited as is our understanding of the brain mechanisms involved.” This makes such experiments difficult to prove. So, scientists turn to potential explanations: patterned stimuli, mirror neurons, and dopamine pathways (p. 952). These will be discussed in further detail when we turn to our second study on music and epilepsy, which offers a more focused look at these theories.
However, as this is a critical paper, Maguire collected further data that is interesting to share. Musical therapy concerns a relationship to musicality. As such, there could be “disastrous effects” to a patient if they rely on musical skills for employment (p. 954). Maguire describes two unique circumstances: one as a result of AEDs and a second following temporal lobe surgery. In the former, patients taking carbamazepine had reduced pitch perception: all but one of them were Japanese (out of 26 reported cases; p. 954). Several theories were put forward by scientists that attempted to pinpoint what part of the brain was being affected. In any case, the phenomenon was reversible upon reduction in dose or discontinuation of the drug.
Temporal lobe surgery is, of course, more complex: depending on the facet of musicality studied, there may or may not be an observed risk of impairment. Something to consider is that the studies cited by Maguire had small sample groups and varied methods. At minimum, the studies seemed to observe that right temporal lobectomy patients were more at risk than left temporal lobectomy patients for post-operative problems (p. 954).
In her conclusion, Maguire recognizes that this area of research is fascinating but underdeveloped. There is not yet strong enough evidence to support music’s anticonvulsant effects, and she summarizes this common theme of the paper by saying: “[…] musical perception occurs via a complex network […]”. It may be too complex to fully explore.
Music Therapy as a Non-pharmacological Treatment for Epilepsy
Music therapy as a non-pharmacological treatment for epilepsy (Liao, Jiang, & Wang, 2015) also offers a glance at pre-existing research, but synthesizes some of the running theories more succinctly. They write from the understanding that many patients ultimately encounter a diagnosis of refractory epilepsy (drug-resistant epilepsy, p. 996). If a clinician researches alternative treatments, they may stumble upon music therapy. Papers such as this help clinicians better understand the potential “why” of music therapy.
The first theory they mention is that of resonation, which suggests that the complex structures of the brain mirror the organization of Mozart’s K.448 – thus, they “resonate with each other” (pp. 994-995). The mirror neuron theory takes a more general approach, simply linking auditory stimuli to the cerebral motor cortex. This focuses on how all of the behaviours associated with music – playing instruments, dancing, and singing – activate neurons in listeners (p. 995). The dopamine pathway theory is especially convincing given that dopamine is said to be involved in the pathophysiological process of epilepsy, including autosomal dominant nocturnal frontal lobe epilepsy, juvenile myoclonic epilepsy, and mesial temporal lobe epilepsy (p. 995). Additionally, one study suggested that dopamine was “protective” in photosensitive epilepsy (ibid.). Therefore, the increase of dopamine as a result of listening to music could make an impression on various types of epilepsy. At this point, however, Liao et al. revisit the idea of seizures induced by epilepsy. Here, they say that different dopamine receptors may be responsible: D2 receptors are responsible for anti-epileptic effects, and D1 receptors for lowering seizure threshold (p. 995). Moving forward, they focus on the theory of parasympathetic activation. Here, researchers found that when Mozart was used in a study (K.448 and K.545), epileptiform discharges were reduced, but so was heart rate.
Liao et al. then consider which types of epilepsy might benefit from music therapy. They begin with Lennox-Gastaut syndrome, on account of how difficult it is to treat and based on a study that showed potentially promising results (p. 996), benign epilepsy with centro-temporal spikes, refractory gelastic epilepsy, refractory epilepsy in children, refractory status epilepticus, and in the prevention of SUDEP (ibid.). Liao et al. reiterate that more research is necessary for each potential application, based on the weak sample sizes of other studies or conflicting physiological mechanisms (e.g., they flag cardiac dysfunction as needing further research in SUDEP).
It should be noted that in the application of music therapy, the effect does not seem permanent and exposure must be repeated. At the end of the article, Liao et al. explain that music therapy as a whole has no consistent treatment plan, and propose their own: 10 minutes an hour upon awakening, 30-45 minutes once a day at any time, 8 minutes before sleep once a day, and 10 hours overnight (p. 998). For the curious neurologist or epileptologist, this could be a starting point.
In Conclusion
Scientific articles on music therapy explore a range of neurological disorders (Parkinson’s, Alzheimer’s, strokes, etc) and psychiatric illnesses (depression, anxiety, ADHD, etc.; Liao et al. p. 998). It makes sense that epilepsy would eventually enter the picture. While studies are uncertain about music’s efficacy as an anticonvulsant, epilepsy may overlap with one or more conditions that could benefit from the treatment. Using ADHD as an example, it has been established that its effects can be tempered by classical music. As these papers explain, Mozart has been favoured in clincal research, but scientists have explored other composers such as Haydn and Liszt for their similar structures (Liao et al., 2015). Some people simply report enjoying other genres of music in the background (Ball, 2023). These nuances fall outside of the scope of this particular article: instead, it is more valuable to recognize music as part of the toolkit for wellness. More than anything, we can return to the idea that music is culturally and spiritually valuable. The brain is powerful and fascinating!
Ball, P. D. (2023, October 01). ‘Like brain candy’: How symphonies, soundwaves, and sitcoms
help some adults with ADHD. CBC. https://www.cbc.ca/news/canada/british-columbia/like-brain-candy-how-symphonies-soundwaves-and-sitcoms-help-some-adults-with-adhd-1.6983258?mkt_tok=MTYxLU9MTi05OTAAAAGOyKGh1SYm0vgwotPDEJdofYmRrQIjvFhEyOHUh-5SbTMgVcSfjiskHZCaqpXvOcC8TxNDVqBasBdddhujGNfc7JtqAoSScTMSewMLW6klNFnkqSONxg
France, H. (2020). Creative Arts and the Indigenous Healing Circle Within an Indigenous
Context/Les arts creatifs et le Cercle de guerison autochtone dans un contexte autochtone. Canadian Journal of Counselling and Psychotherapy, 54(3), 413-429.
Liao, H., Jiang, G., & Wang, X. (2015). Music therapy as a non-pharmacological treatment for
epilepsy. Expert Review of Neurotherapeutics, 15(9), 993–1003. https://doi.org/10.1586/14737175.2015.1071191
Maguire, M. J. (2012). Music and epilepsy: A critical review. Epilepsia, 53(6), 947–961.
https://doi.org/10.1111/j.1528-1167.2012.03523.x
