Assistant Professor, Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
*Correspondence to: Dr. Ruchika Tandon, Assistant Professor, Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Copyright © 2022 Dr. Ruchika Tandon. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 29 January 2022
Published: 02 February 2022
Keywords: Music; Neurology; Neuroplasticity; Neurostimulation
Researchers worldwide are utilizing the therapeutic and healing properties of music for treatment and rehabilitation of patients with medical illnesses. In recent times, it is increasingly being used for neurological diseases, as well. Hence, we reviewed the effects of music on people with neurological diseases and its therapeutic potential.
We did a PubMed search for the terms “Music and Medicine”, “Music and Neurological Diseases” and selected the relevant studies and then compiled the results of these studies to get an insight into the therapeutic potential of music for patients suffering from various neurological ailments.
Music may help in relieving medical and surgical pain. It may help people with dementia, movement disorders, epilepsy, multiple sclerosis, traumatic brain injury, fibromyalgia, anxiety, depression and other psychiatric illnesses and those with less arousal states. Children with developmental and acquired deficits, those in pain and those undergoing electrodiagnostic procedures may all benefit by music. Treatment employing music may have hormonal, neurotransmitter-related and neurostimulatory effects and may alter neuroplasticity.
Music may be beneficial in Neurology and more research may yield more information about the its mechanism of action on human brain.
Since times immemorial, music continues to be a part and parcel of daily life of human beings as well as some animals like singing birds and the fossil studies show the oldest records of musical instruments from France (around 18000 years before present), Germany (43,150-39,370 years before present) and from Slovenia (belonging to Neanderthals) . Hence, the exact singing and musical ability of humans as we know it today has evolved gradually over time and there are genetic and environmental theories to account for the same. We now know that music training upregulates the target genes of FOXP2 (forkhead box protein P2), the alpha- synuclein gene (SNCA) and also microRNAs. On the other hand, music switches off the genes targeted by transcription regulators for proinflammatory cytokines and those for the apoptosis of the nerve cells . Even studies show an aptitude for music among twins.
Music and Medicine
Due to its pleasant and healing effects, music may treat patients with medical illness . Previously, the scholars have defined music therapy as the “systematic use of music within a therapeutic relationship which aims at restoring, maintaining and furthering emotional, physical and mental health” . Premature infants, patients with cardiac diseases, neurological diseases, gastrointestinal diseases, respiratory illnesses, metabolic issues, psychiatric disorders, chronic cancer pain, surgical procedures, radiological procedures, dental procedures, anesthesia services and palliative care services may all utilize music as a form of treatment [3-14].
Music and Neurological Diseases
Not infrequently, oncologists may call a neurologist to manage pain and listening to music may help in managing chemotherapy related pain  and medical or surgical procedure related pain [16,17].
According to previous literature, music intervention may improve spatial skills of people with dementia and otherwise also help these individuals [18,19]. Apart from its beneficial effects on individuals with stroke and dementia, music therapy, including singing, dancing and instrumental music may improve cognition, attention, memory, motor function, gait, speech and emotional state of people with Alzheimer’s disease, Parkinson’s disease and other movement disorders like Huntington disease, Tourette syndrome and progressive supranuclear palsy, epilepsy and multiple sclerosis [20-22]. According to a study on patients with Parkinson’s disease, groupbased music intervention helped in mood, alertness, and improving overall quality of life but did not help in dual-tasking, cognition, balance, or freezing of gait in these individuals .
A randomized control trial found it to be no better than conventional physiotherapy for motor recovery of the upper limb function following stroke . Nevertheless, it may improve speech in severe non fluent aphasia  and may induce muscle relaxation in patients having hypertonia .
In a previous research article, investigators did not find a significant decrease in pain and anxiety after listening to music while undergoing electromyography  and listening to music at bedtime before sleeping may increase symptoms of restless legs syndrome due to disruption in sleep . Nevertheless, music helps in post-stroke depression .
Studying traumatic brain injury patients, the previous researchers are of the opinion that gray matter volume increases significantly in the right inferior frontal gyrus following music treatment .
The doctors are also trying music treatment in patients in low awareness states .
For those who are on mechanical ventilation also one may use various genres of music, for example classical, jazz, rock, country, oldies and utilize instruments like piano, voice, guitar, music with nature sounds, and orchestral music for managing anxiety and pain [32,33]. There are, however, some trials, which refute these observations . Singing and playing wind instruments may help in improving the respiratory function of people with chronic neurological diseases . Functional disorders as well as pain in fibromyalgia may, however, benefit by music [36,37].
Music and Children in Neurology
For electrodiagnostic studies in children, music may be comparable to medical sedation .
By enhancing temporal processing and rhythm abilities, music intervention may improve phonological awareness and reading skills in dyslexia . It may reduce tics in Tourette’s syndrome, benefit in autism spectrum disorder, Rett syndrome, children with disabilities, hypertonia, epilepsy, mental health, neonatal care, neurorehabilitation, and help reduce pain and anxiety levels in medical procedures, in pediatric oncology and in palliative care [40-42].
Even during fetal stage, different aspects of music like timing, timbre, repertoire and entrainment may play a crucial role in affecting and shaping the neuroplasticity .
How Music Influences the Brain?
Music may alter the neural systems for reward, arousal, affect regulation, learning and activitydriven neuroplasticity in human brains . Additionally, the functional MRI studies prove the remodeling of motor and auditory cortex in professional musicians.
Neurotransmitter and hormonal changes take place with music. Furthermore, Mozart’s music improves neuropsychological activity leading to “The Mozart Effect”  and the researchers are utilizing this “Mozart Effect” (Mozart’s sonata for two pianos in D major, K448) to not only reduce the frequency of seizures in epilepsy but also in children with drug refractory epileptic encephalopathies . According to a study on neonates in the intensive care unit, listening to music affected the functional connectivity on scalp electroencephalography  and another study employing Indian classical music affected EEG waves of patients with traumatic brain injury .
An interesting aspect of music is that during olden days, there was a class of people who believed that music may even be pathological due its neurostimulatory effects, though the so-called effects may have been psychosomatic or related to the existing sociocultural norms rather than physiological . This reminds us of the fact that music training may be counterproductive as is the case of ‘musician’s dystonia’  or ‘musicogenic epilepsy’ .
Last but not the least, teaching music to the doctors may help in fostering humanism in medicine  and hence, there is a growing need for imparting a music cognition research training to the neurologists in particular .
- Gochenour, K. S., Ellis, R. S., Meredith, S. L., Vesely, K. C., Kang, P. & Haefner, S. (2020). Music and medicine come together over pain in the air medical transport environment. Air Med J., 39(6), 484-488.
- Bashiri, M., Akçalı, D., Coşkun, D., Cindoruk, M., Dikmen, A. & Çifdalöz, B. U. (2018). Evaluation of pain and patient satisfaction by music therapy in patients with endoscopy/colonoscopy. Turk J Gastroenterol., 29(5), 574-579.
- Gasenzer, E. R., Neugebauer, E. A. (2011). Die Beziehung von Musik und Medizin in Geschichte und Gegenwart [The relations between music and medicine in history and present]. Dtsch Med Wochenschr., 136(51-52), 2644-2651.
- Lieber, A. C., Bose, J., Zhang, X., Seltzberg, H., Loewy, J., Rossetti, A., et al. (2019). Effects of music therapy on anxiety and physiologic parameters in angiography: a systematic review and meta-analysis. J Neurointerv Surg., 11(4), 416-423.
- Park, G., Weiss, S. J. & Repar, P. (2015). Randomized single-blinded clinical trial on effects of nursery songs for infants and young children's anxiety before and during head computed tomography. Am J Emerg Med., 33(10), 1477-1482.
- Di Nasso, L., Nizzardo, A., Pace, R., Pierleoni, F., Pagavino, G. & Giuliani, V. (2016). Influences of 432 hz music on the perception of anxiety during endodontic treatment: a randomized controlled clinical trial. J Endod., 42(9), 1338-1343.
- Mondanaro, J. F., Sara, G. A., Thachil, R., Pranjić, M., Rossetti, A., EunHye Sim, G., et al. (2021). The Effects of clinical music therapy on resiliency in adults undergoing infusion: a randomized, controlled trial. J Pain Symptom Manage., 61(6), 1099-1108.
- Ovayolu, N., Ucan, O., Pehlivan, S., Pehlivan, Y., Buyukhatipoglu, H., Savas, M. C. & Gulsen, M. T. (2006). Listening to Turkish classical music decreases patients' anxiety, pain, dissatisfaction and the dose of sedative and analgesic drugs during colonoscopy: a prospective randomized controlled trial. World J Gastroenterol., 12(46), 7532-7536.
- Rodakowski, J., Dorris, J. L., McLaughlin, D. J. & Grimes, D. L. (2021). Music intervention pilot study: assessing teaching methods of group marimba classes designed to train spatial skills of older adults with changes in cognition. Music Med., 13(4).
- Loewy, J., Torossian, A., Appelbaum, M., Fleming, A. & Tomaino, C. (2020). Lincoln center moments: integrating accessibility and enhancement through expanding performing arts experiences. Arts Health., 12(2), 182-193.
- Grau-Sanchez, J., Duarte, E., Ramos-Escobar, N., Sierpowska, J., Rueda, N., Redon, S., et al. Music-supported therapy in the rehabilitation of subacute stroke patients: a randomized controlled trial. Ann N Y Acad Sci.
- Lim, K. B., Kim, Y. K., Lee, H. J., Yoo, J., Hwang, J. Y., Kim, J. A. & Kim, S. K. (2013). The therapeutic effect of neurologic music therapy and speech language therapy in post-stroke aphasic patients. Ann Rehabil Med., 37(4), 556-562.
- Lin, F., Gu, Y., Wu, Y., Huang, D. & He, N. (2017). Effect of music therapy derived from the five elements in Traditional Chinese Medicine on post-stroke depression. J Tradit Chin Med., 37(5), 675-680.
- Siponkoski, S. T., Martínez-Molina, N., Kuusela, L., Laitinen, S., Holma, M., Ahlfors, M., et al. Music therapy enhances executive functions and prefrontal structural neuroplasticity after traumatic brain injury: evidence from a randomized controlled trial. J Neurotrauma., 37(4), 618-634.
- Hetland, B., Lindquist, R., Weinert, C. R., Peden-McAlpine, C., Savik, K. & Chlan, L. (2017). Predictive associations of music, anxiety, and sedative exposure on mechanical ventilation weaning trials. Am J Crit Care., 26(3), 210-220.
- Ang, K., Maddocks, M., Xu, H. & Higginson, I. J. (2017). The effectiveness of singing or playing a wind instrument in improving respiratory function in patients with long-term neurological conditions: a systematic review. J Music Ther., 54(1), 108-131.
- Zemlyanaya, A. A., Radchenko, G. S. & Fedotchev, A. I. (2018). Music therapy procedures controlled by the brain potentials in treatment of functional disorders. Zh Nevrol PsikhiatrIm S SKorsakova., 118(3), 103-106.
- Garza-Villarreal, E. A., Wilson, A. D., Vase, L., Brattico, E., Barrios, F. A., Jensen, T. S., et al. (2014). Music reduces pain and increases functional mobility in fibromyalgia. Front Psychol., 5, 90.
- Loewy, J., Hallan, C., Friedman, E. & Martinez, C. (2006). Sleep/sedation in children undergoing EEG testing: a comparison of chloral hydrate and music therapy. Am J Electroneurodiagnostic Technol., 46(4), 343-355.
- Flaugnacco, E., Lopez, L., Terribili, C., Montico, M., Zoia, S. & Schön, D. (2015). Music training increases phonological awareness and reading skills in developmental dyslexia: a randomized control trial. PLoS One., 10(9), e0138715.
- Chou, M. Y., Chang, N. W., Chen, C., Lee, W. T., Hsin, Y. J., Siu, K. K., et al. (2019). The effectiveness of music therapy for individuals with Rett syndrome and their families. J Formos Med Assoc., 118(12), 1633-1643.
- Coppola, G., Toro, A., Operto, F. F., Ferrarioli, G., Pisano, S., Viggiano, A. & Verrotti, A. (2015). Mozart's music in children with drug-refractory epileptic encephalopathies. Epilepsy Behav., 50, 18-22.
- Akiyama, A., Tsai, J. D., W Y Tam, E., Kamino, D., Hahn, C., Go, C. Y., et al. (2021). The Effect of music and white noise on electroencephalographic (eeg) functional connectivity in neonates in the neonatal intensive care unit. J Child Neurol., 36(1), 38-47.
- Ushasree, B., Al Anzari, A., Sampath Kumar, N. S., Phanisree, P., Indira, S., Moscote-Salazar, L. R. & Agrawal, A. (2021). Post music session real-time EEG changes in patients who underwent neurosurgical intervention for neuronal dysfunction. Neurol India., 69(4), 1024-1026.
- Gordon, R. L. & Lense, M. D. (2020). Interprofessional education of the next generation of musician-scientists through music cognition research training: An innovative platform for health professions and biomedical research. Music Med., 12(1), 37-41.