Rei-Cheng Yang

Mozart K.448 and epileptiform discharges: Effect of ratio of lower to higher harmonics

PURPOSE Certain music has been shown to improve mental function, leading to what is known as the Mozart effect. This study measured the impact of Mozarts Sonata for two pianos in D major, K.448, on different epileptic foci of epileptiform discharge in Taiwanese children (n=58) with seizure disorders and investigated the characteristics of the musical stimulus presented that resulted in epileptiform discharge reduction. METHODS We examined the relationship between the number of discharges with the foci of epileptiform discharge (n=6), sleep state, gender, and mentality. A continuous electroencephalogram was recorded before, during and after exposure to Mozarts Sonata for two pianos in D major, K.448 (piano K.448), and the frequencies of discharges were compared. The study was repeated a week later using digitally computerized string version of the same musical stimulus (string K.448), in patients who responded to piano K.448 with the largest reduction in interictal discharges (n=11). RESULTS Interictal discharges were reduced in most (81.0%) patients and varied greatly (33.10+/-28.33%) as they listened to the piano K.448 (more fundamental tones and lower harmonics). Patients with generalized or central discharge showed the most improvement. In most patients (76.1%), the decrease in epileptiform discharges continued after the music ended. The state of wakefulness, gender and mentality did not affect the results. Although the string K.448 had a larger number of higher harmonics in the spectrogram analysis, the discharges were not reduced at all when listening to this music. CONCLUSION These results suggest that listening to Mozart K.448 for two pianos reduced epileptiform discharges in children with epilepsy. This study suggests that it is possible to reduce the number of epileptiform discharges in some patients by optimizing the fundamental tones and minimizing the higher frequency harmonics.

The long-term effect of listening to Mozart K.448 decreases epileptiform discharges in children with epilepsy

Mozarts Sonata for Two Pianos in D major, K.448 (Mozart K.448), has been shown to improve mental function, leading to what is known as the Mozart Effect. Our previous work revealed that epileptiform discharges in children with epilepsy decrease during and right after listening to Mozart K.448. However, the duration of the effect was not studied. In the study described here, we evaluated the long-term effect of Mozart K.448 on epileptiform discharges in children with epilepsy. Eighteen children with epilepsy whose seizures were clinically well controlled with antiepileptic drugs were included. For each child, EEGs had revealed persistent epileptiform discharges for at least 6 months. These patients listened to Mozart K.448 for 8 minutes once a day before bedtime for 6 months. Epileptiform discharges were recorded and compared before and after 1, 2, and 6 months of listening to Mozart K.448. All of the children remained on the same antiepileptic drug over the 6 months. Relationships between number of epileptiform discharges and foci of discharges, intelligence, epilepsy etiology, age, and gender were analyzed. Epileptiform discharges significantly decreased by 53.2±47.4, 64.4±47.1, and 71.6±45.8%, respectively, after listening to Mozart K.448 for 1, 2, and 6 months. All patients except those with occipital discharges showed a significant decrease in epileptiform discharges. Patients with normal intelligence and idiopathic epilepsy had greater decreases than those with mental retardation and symptomatic epilepsy. Age and gender did not affect the results. We conclude that long-term listening to Mozart K.448 may be effective in decreasing epileptiform discharges in children with epilepsy in a chronologically progressive manner.

Oxcarbazepine-induced Stevens-Johnson Syndrome: A Case Report

Although carbamazepine (CBZ) is the most common cause of Stevens‐Johnson syndrome (SJS), a new anticonvulsant, oxcarbazepine, which is structurally related to carbamazepine, has been shown to induce SJS, although extremely rarely. Recently, a strong association was found between human leukocyte antigen (HLA) B*1502 and CBZ‐induced SJS/TEN in a Han Chinese population. Here, we report a case with SJS, which was induced by oxcarbazepine. HLA genotyping in the patient showed HLA‐B*1518/B*4001. HLA‐B*1518 is a HLA‐B15 variant. The genetic significance of HLA‐B*1518 in association with oxcarbazepine‐induced SJS needs to be further studied.

Mozart K.448 acts as a potential add-on therapy in children with refractory epilepsy

Mozarts Sonata for two pianos in D major, K.448 (Mozart K.448), has been shown to improve mental function, leading to what is known as the Mozart effect. Our previous work revealed that epileptiform discharges in children with epilepsy decreased during and immediately after listening to Mozart K.448. In this study, we evaluated the long-term effects of Mozart K.448 on children with refractory epilepsy. Eleven children with refractory epilepsy were enrolled. All of the patients were diagnosed as having had refractory epilepsy for more than 1 year (range =1 year to 6 years 4 months, mean =3 years 11 months) and had been receiving at least two antiepileptic drugs (AED). During the study period, they listened to Mozart K.448 once a day before bedtime for 6 months. Seizure frequencies were recorded 6 months before they started listening to this music and monthly during the study period. All of the patients remained on the same AEDs during the 6-month study period. Frequencies of seizures were compared before and after listening to Mozart K.448. Eight of eleven patients were seizure free (N=2) or had very good responses (N=6) after 6 months of listening to Mozart K.448. The remaining three (27.3%) showed minimal or no effect (effectiveness <50%; unmodified or worsened seizure frequency). The average seizure reduction was 53.6 ± 62.0%. There were no significant differences in seizure reduction with IQ, etiology, or gender. We conclude that Mozart K.448 should be further studied as a potential add-on therapy in the treatment of children with refractory epilepsy.

Parasympathetic activation is involved in reducing epileptiform discharges when listening to Mozart music

OBJECTIVE Listening to Mozart K.448 has been demonstrated to improve spatial task scores, leading to what is known as the Mozart effect. Our previous work revealed the positive effects of Mozart K.448 in reducing epileptiform discharges in children with epilepsy. However, the mechanism remains unclear. parasympathetic activation has been shown to help seizure control in many studies. In this study, we investigated the effect of Mozart music on epileptiform discharges and autonomic activity. METHODS Sixty-four epileptic children with epileptiform discharges were included. They all received electroencephalogram and electrocardiogram examinations simultaneously before, during, and after listening to Mozart K.448 or K.545. The total number of epileptiform discharges during each session (before, during, and after music) were divided by the duration (in minutes) of the session and then compared. Heart rate variability including time and frequency domain analysis was used to represent the autonomic function. RESULTS The results showed that epileptiform discharges were significantly reduced during and right after listening to Mozart music (33.3 ± 31.1% reduction, p<0.001, during Mozart K.448 and 38.6 ± 43.3% reduction, p<0.001, during Mozart K.545) (28.1 ± 43.2% reduction, p<0.001, after Mozart K.448 and 46.0 ± 40.5% reduction, p<0.001, after Mozart K.545). No significant difference was noticed between the two pieces of music. The reduction was greatest in patients with generalized seizures and discharges. Significant increases in high-frequency (HF), the square root of the mean squared differences of successive RR intervals (RMSSD), the standard deviation of differences between adjacent RR intervals (SDSD), and a decrease in mean beats per minute (bpm) were found during listening to Mozart music. Most of the patients with reduced epileptiform discharges also showed a decreased LF/HF ratio, low-frequency normalized units (LF nu), mean bpm, and an increased high-frequency normalized units (HF nu). CONCLUSIONS Listening to Mozart music decreased epileptiform discharges in children with epilepsy. The majority of these patients showed an increase in parasympathetic tone during music exposure. SIGNIFICANCE Our results suggested that Mozart music stimuli induced parasympathetic activation which may be involved in the effect of music in reducing epileptiform discharges and the recurrence rate of seizures.

Mozart K.545 Mimics Mozart K.448 in Reducing Epileptiform Discharges in Epileptic Children

Mozart K.448 has been shown to improve cognitive function, leading to what is known as the Mozart Effect. Our previous work reveals positive effects of Mozart K.448 in reducing epileptiform discharges in epileptic children. In this study, we evaluated the effect of Mozart K.545 and compared the effects with those of Mozart K.448 on epileptiform discharges in children with epilepsy. Thirty-nine epileptic children with epileptiform discharges were included in the study. They received electroencephalogram examinations before, during, and after listening to Mozart K.448 and K.545, one week apart, respectively. The frequencies of epileptiform discharges were compared. There was a significant decrease in the frequency of epileptiform discharges during and right after listening to Mozart K.448 and K.545 (reduced by 35.7 ± 32.7% during Mozart K.448 and 30.3 ± 44.4% after Mozart K.448; and 34.0 ± 39.5% during Mozart K.545 and 31.8 ± 39.2% after Mozart K.545). Spectrogrammatic analysis of the two pieces of music demonstrated that both share similar spectrogrammatic characteristics. Listening to Mozart K.448 and K.545 decreased the epileptiform discharges in epileptic children. This suggests that Mozart K.448 is not the only piece of music to have beneficial effects on children with epilepsy. Other music with lower harmonics may also decrease epileptiform discharges in epileptic children.

Assisted exercise improves bone strength in very low birthweight infants by bone quantitative ultrasound

Aim:  To evaluate whether assisted exercise could prevent the development of osteopenia of prematurity, we performed assisted exercise in the study group of very low birthweight (VLBW) premature infants.

EARLY PREDICTION OF MEDICATION REFRACTORINESS IN CHILDREN WITH IDIOPATHIC EPILEPSY BASED ON SCALP EEG ANALYSIS

Refractory epilepsy often has deleterious effects on an individuals health and quality of life. Early identification of patients whose seizures are refractory to antiepileptic drugs is important in considering the use of alternative treatments. Although idiopathic epilepsy is regarded as having a significantly lower risk factor of developing refractory epilepsy, still a subset of patients with idiopathic epilepsy might be refractory to medical treatment. In this study, we developed an effective method to predict the refractoriness of idiopathic epilepsy. Sixteen EEG segments from 12 well-controlled patients and 14 EEG segments from 11 refractory patients were analyzed at the time of first EEG recordings before antiepileptic drug treatment. Ten crucial EEG feature descriptors were selected for classification. Three of 10 were related to decorrelation time, and four of 10 were related to relative power of delta/gamma. There were significantly higher values in these seven feature descriptors in the well-controlled group as compared to the refractory group. On the contrary, the remaining three feature descriptors related to spectral edge frequency, kurtosis, and energy of wavelet coefficients demonstrated significantly lower values in the well-controlled group as compared to the refractory group. The analyses yielded a weighted precision rate of 94.2%, and a 93.3% recall rate. Therefore, the developed method is a useful tool in identifying the possibility of developing refractory epilepsy in patients with idiopathic epilepsy.

LOWER PLASMA NEUROPEPTIDE Y LEVEL IN PATIENTS WITH ATYPICAL FEBRILE CONVULSIONS

Febrile convulsion (FC) is the most common neurological disease in children. Cases with seizures that persist for more than 15 minutes or recurrent seizures within the same febrile illness are considered to be atypical and may have a different prognosis. Neuropeptide Y (NPY), an endogenous anticonvulsant that is widely distributed throughout the central nervous system, including the hippocampus, is known to prevent seizures by increasing the seizure threshold. Based on our previously finding that patients with atypical FC have lower concentrations of NPY, we hypothesized that the concentration of NPY may play a role in the development of atypical FC. To investigate this hypothesis, we used a radioimmunoassay to measure the plasma NPY concentration of 60 children with FC (typical FC, n = 46; atypical FC, n = 14) and 56 age‐matched controls. The atypical FC group had significantly lower concentrations of NPY than children with typical FC and controls (66.47 ± 19.11 pmol/L vs. 88.68 ± 28.50 pmol/L and 86.82 ± 22.66 pmol/L, respectively). Very low NPY levels were found in two patients; one patient (NPY level: 44.75 pmol/L) experienced prolonged seizures lasting for up to 1 hour and the other had recurrent seizures (three seizures) during the same febrile illness (NPY level: 33.53 pmol/L). These results suggest that patients with inadequate NPY inhibitory activity are more susceptible to atypical FC.

Heat shock pretreatment attenuates sepsis-associated encephalopathy in LPS-induced septic rats

Sepsis is the most common cause of mortality in intensive care units. Although sepsis-associated encephalopathy (SAE) is reported to be a leading manifestation of sepsis, its pathogenesis remains unclear. In our previous studies, we showed that heat shock pretreatment can reduce mortality in polymicrobial septic rats and protect the cerebral cortical function during hypoxia or drug-induced convulsion. In the present study, we investigated to what extent heat shock pretreatment might affect the development of SAE in septic rats and the possible mechanism behind its effect was discussed. To do this, we used lipopolysaccharide (LPS) to induce septic response in a SAE animal model. Heat shock pretreatment was performed and rectal temperature maintained between 41 and 42 degrees C for 15 min using an electric heating pad. Electroencephalography (EEG) activity, a sensitive electrophysiological recording of electrical activity in the brain, was used as an indicator of cerebral cortical dysfunction in SAE. In LPS rats not pretreated with heat shock, the EEG background activity decreased 10 min after intraperitoneal administration of LPS. However, in rats pretreated with heat shock, this decrease was significantly attenuated. Untreated septic rats were also found to have earlier, more frequent epileptic spikes. In summary, we found that heat shock could attenuate the electro-cortical dysfunction in rats with LPS-induced septic response, suggesting that heat shock response might potentially be used to prevent SAE in sepsis.