Summary: Patients undergoing testing for epilepsy often experience significant distress when their medication is reduced to provoke seizures. However, a recent study reveals that listening to live improvisatory viola music helps these patients achieve a meditative state, as shown by EEG measurements.
This calming effect allows testing to proceed and reduces self-reported stress and anxiety. The research offers promising implications for non-pharmacological interventions in healthcare.
Live improvisatory viola music reduced the patients’ brain wave frequencies to an alpha state, indicating a meditative, calm state.
The viola was specifically chosen for its pitch range, which falls within the human “safe” vocal range known to activate the brain’s calming systems.
While listening to recorded favorites did not show the same impact, the live, personalized 40-minute music session over FaceTime was clinically effective.
Source: Northwestern University
Patients with epilepsy endure difficult conditions in the hospital to undergo testing. They must temporarily stop or decrease their medications during their hospitalization to provoke seizures. Many feel distressed and anxious. Some are so uncomfortable, they cannot complete their testing.
But when these patients listened to improvisatory music — a violist playing live music who responded to their state of agitation in real time — the patients’ brain waves (as monitored on an EEG) slowed to a calmer state, allowing the testing to continue. Patients also reported decreased feelings of stress and anxiety after their clinical music experience.
“Their brains went into a meditative state,” said lead investigator Dr. Borna Bonakdarpour, associate professor of neurology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine neurologist.
“When they engaged with the real world, such as watching a TV show or browsing social media on their phone, their brain frequency was an average of 12 or 13 (beta waves) Hertz, but after the music it dropped to an 8 or 9, which is the alpha state.”
The study was published Sept. 1 in Frontiers of Neurology.
The viola was chosen for this research due to its pitch range reflecting the human “safe” vocal range, which is the two middle octaves. Research shows this range, used for lullabies, activates the calming systems of the brain.
“There has been a scarcity of non-pharmacological interventions for epilepsy patients in the hospital, and we show that the patients benefited significantly from music intervention,” Bonakdarpour said.
“Importantly, the patients’ self-reports correlated with objective EEG changes, which is something that had not been previously done in an epilepsy-monitoring unit.”
The study with five patients was small, but Bonakdarpour is planning a larger clinical trial with 30 to 50 patients.
The impact of the findings may apply to patients in the hospital for other reasons, Bonakdarpour said.
“Music as a clinical tool is underutilized in outpatient settings and in hospitals,” he said.
During the pilot study, 21 patients with epilepsy were identified as suitable for the trial. Five of these individuals were reported by the nursing and social work staff to have significant distress and were included in this study to receive the intervention. Listening to recordings of their favorite songs alone did not seem to be effective for these patients.
Participants in the study received a personalized 40-minute live music session over FaceTime by a clinically trained violist in consultation with a music therapist.
Clinically designed improvisatory music has simple meandering melodies played at a slow tempo. The improvisation is slow and meterless, played in the form of two-minute-long statements with an ending that tapers to silence.
The music was offered as part of the Northwestern Medicine Telemusic Intervention program during COVID-19 lockdown to relieve patients’ distress in the Northwestern Memorial Hospital neurosciences unit. The results of the broader study included 87 sessions during a three-month period.
Northwestern co-authors include: Guangyu Zhou, Daniel Huang, Catherine Vidano, Stephan Schuele, Christina Zelano and Clara Takarabe.
Funding: The research is funded by National Institutes of Deafness and other Communication Disorders (NIDCD) grant R01-DC-018539 of the National Institutes of Health and Northwestern’s department of neurology philanthropy.
About this music therapy and epilepsy research news
Calming Effect of Clinically Designed Improvisatory Music for Patients Admitted to the Epilepsy Monitoring Unit during the COVID-19 Pandemic: A Pilot Study
Background: Epilepsy monitoring requires simulating seizure-inducing conditions which frequently causes discomfort to epilepsy monitoring unit (EMU) patients. COVID-19 hospital restrictions added another layer of stress during hospital admissions. The purpose of this pilot study was to provide evidence that live virtual Clinically Designed Improvisatory Music (CDIM) brings relief to EMU patients for their psychological distress.
Methods: Five persons with epilepsy (PWEs) in the EMU during the COVID-19 lockdown participated in the study (average age ± SD = 30.2 ± 6 years). Continuous electroencephalogram (EEG) and electrocardiogram (EKG) were obtained before, during, and after live virtual CDIM. CDIM consisted of 40 minutes of calming music played by a certified clinical music practitioner (CMP) on viola. Post-intervention surveys assessed patients’ emotional state on a 1–10 Likert scale. Alpha/beta power spectral density ratio was calculated for each subject across the brain and was evaluated using one-way repeated analysis of variance, comparing 20 minutes before, during, and 20 minutes after CDIM. Post-hoc analysis was performed using paired t-test at the whole brain level and regions with peak changes.
Results: Patients reported enhanced emotional state (9 ± 1.26), decrease in tension (9.6 ± 0.49), decreased restlessness (8.6 ± 0.80), increased pleasure (9.2 ± 0.98), and likelihood to recommend (10 ± 0) on a 10-point Likert scale. Based on one-way repeated analysis of variance, alpha/beta ratio increased at whole-brain analysis (F3,12 = 5.01, P = 0.018) with a peak in midline (F3,12 = 6.63, P = 0.0068 for Cz) and anterior medial frontal region (F3,12 = 6.45, P = 0.0076 for Fz) during CDIM and showed a trend to remain increased post-intervention.
Conclusion: In this pilot study, we found positive effects of CDIM as reported by patients, and an increased alpha/beta ratio with meaningful electroencephalographic correlates due to the calming effects in response to CDIM. Our study provides proof of concept that live virtual CDIM offered demonstrable comfort with biologic correlations for patients admitted in the EMU during the COVID-19 pandemic.