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Letters to the Editor

icant levels of inattentive and/or hyperactive–impul- sive behaviors. As noted by Dr. Warner, however, our children have been recruited from a tertiary medical center, and it would be important to determine if problems with inattention are found in a sample of children in a community-based practice. We believe that the relationship between attention and learning in children with epilepsy may provide a critical link in understanding problems with achievement. We also believe that it is important to determine the risk of comorbidity of ADHD in children with epilepsy as well as the long-term course of these symptoms.

The Mozart Effect

To the Editor:

In his article, “Review of the Mozart Effect,” John Hughes concentrated on his seminal experiments showing decreased neuropathological spiking activity during exposure of epilepsy patients to a Mozart so- nata (K.448) and on his extensive computer analyses of many pieces of music to try to account for the Mozart effect phenomena (1). I give here a comple- mentary broader scope of the relevant cortical theory, behavioral experiments, and brain imaging studies all adding further insight into this discovery of large scientific as well as large general interest. This allows an overview of topics of clinical relevance. Based on the Mountcastle (2, 3) columnar organiza- tion principle, the trion model (4–6) yields an innate internal cortical language represented by spatial–tem- poral memory firing patterns. The brain’s innate abil- ity to relate (through symmetry operations) these memory patterns is proposed to be the unifying phys- iological mechanism of higher brain function. The finding by Leng et al. that the structure of the trion memory patterns and their symmetry relationships were those of recognizable human styles of music (a selection of Xiaodan Leng’s original trion music pieces (7) is appended to the on-line version of this Letter 1 ) astonished us. It led to the prediction (4) in 1991 that “music was a window into higher brain” and that specific music could causally enhance spatial–tempo- ral reasoning. Spatial–temporal reasoning involves maintaining, transforming, and comparing mental im- ages in space and time using symmetry operations, as,

1 Attached is Dr. Xiaodan Leng’s “Trion music” in mp3 format, which can be played using QuickTime software.



1. Williams J, Phillips T, Griebel M, Sharp G, Lange B, Edgar T, Simpson P. Factors associated with academic achievement in chil- dren with controlled epilepsy. Epilepsy Behav 2001;2:217–23.

Jane Williams, Ph.D. Gregory Sharp, M.D.

Department of Pediatrics University of Arkansas for Medical Science 800 Marshall Little Rock, Arkansas 72202


for example, in chess. This theory led to a wide range of experiments supporting this prediction:

1. College students after listening to the first 10

minutes of the Mozart Sonata for Two Pianos in D Major (K.448) showed subsequent short-term (10–15 min- utes) enhancement of spatial–temporal reasoning (8, 9). These causal results in 1993 received an enormous amount of attention and were called the Mozart effect by the media. Frances Rauscher and I chose Mozart since he was composing at age 4 and could write down an entire composition without changing a note. Thus we felt that Mozart was the prime candidate for his music to resonate with the innate columnar cortical structure. Note that it was the college students who were below average on the pretest that had, by far, the largest enhancement (60%) from listening to the

Mozart sonata. (For a meta-analysis of the literature on all the listening experiments see (10).)

2. Alzheimer patients (11, 12), after listening to the

Mozart sonata, had enhanced short-term spatial–tempo-

ral reasoning. The subjects who did not improve from pretest to posttest after a listening condition of silence or 1930s “popular piano music” had substantial increases after listening to the Mozart sonata (K.448).

3. Exposure in epileptic patients, even in a coma, to

the Mozart sonata reduced neuropathological spiking

activity (13). The potential for long-term reduction was found by Hughes et al. (14) and discussed in Hughes’ review (1).

4. Long-term exposure to the Mozart sonata pro-

duced enhanced learning of a maze by rats; the en- hanced performance lasted more than 4 hours after the last exposure to music (15). You definitely do not want to give a child such long-term exposure to any music.

© 2001 Elsevier Science All rights reserved.


However, this does open the possibility of some long- term enhancement from a moderate amount of listen- ing to specific music over a long period.

5. An EEG coherence study (16) gave evidence for a

carryover from the Mozart sonata listening condition to the subsequent spatial–temporal task in relevant cortical regions.

6. fMRI studies comparing cortical blood oxygenation

activation by the Mozart sonata versus other music (the 1930s control music in the Alzheimer studies and the epilepsy studies, and Beethoven’s Fur Elise) gave striking results (17). In addition to expected fMRI activation in cortical regions associated with music (temporal cortex), substantial activation was found in brain regions (dor- solateral prefrontal cortex, occipital cortex, and cerebel- lum) all expected to be important for spatial–temporal reasoning. fMRI studies including spatial–temporal tasks as well as the music listening conditions should be

extremely valuable not only in testing this expectation, but in determining which other music might provide similar enhancements in spatial–temporal reasoning.

We refer collectively to these six behavioral (includ- ing the animal model) and neurophysiological phe- nomena resulting from exposure (to music giving sim- ilar positive effects as exposure) to the Mozart sonata (K.448) as the Mozart effect generalized. (In a related manner, a large relevance of music training to math education through a spatial–temporal approach has been established (6, 18, 19).) These six very different experiments of the Mozart effect along with the motivating and guid- ing trion columnar model of the cortex should be considered together in attempts to understand and explore for potential clinical use (6). In particular, let us look at the intriguing possibility presented by Hughes et al. (1, 14) that repeated exposure to the Mozart sonata (K.448) might lead to a long-term decrease in neuropathology in young epileptic pa- tients. The rat experiments of Rauscher et al. (15) demonstrated that the generalized Mozart effect can be made long-term (longer than 4 hours) by long repeated exposure to the sonata. This seems quite encouraging. The fMRI experiments offer the possi- bility (17), patient by patient, of observing if the brains regions excited by the Mozart sonata overlap with their relevant foci of epileptic activity. This might correlate with the finding by Hughes et al. (1, 13) that some patients with bipolar foci had a de- crease of discharge during the Mozart sonata on the left hemisphere focus and others on the right. Fur- ther, the trion model (20) provides theoretical sup-

© 2001 Elsevier Science All rights reserved.

Letters to the Editor

port for Hughes’ proposal. In conclusion, this non- invasive (with no known side effects) potential clin- ical treatment for epilepsy should receive major consideration.


1. Hughes JR. Review of the Mozart effect. Epilepsy Behav 2001;2:

2. Mountcastle VB. An organizing principle for cerebral function:

the unit module and the distributed system. In: Edelman GM, Mountcastle VB, editors. The mindful brain. Cambridge: MIT,


3. Mountcastle VB. Perceptual neuroscience: the cerebral cortex. Cambridge: Harvard, 1998.

4. Leng X, Shaw GL. Toward a neural theory of higher brain function using music as a window. Concepts Neurosci 1991;2:


5. Shaw GL, Silverman DJ, Pearson JC. Model of cortical or- ganization embodying a basis for a theory of information processing and memory recall. Proc Natl Acad Sci USA 1985;


6. Shaw GL. Keeping Mozart in mind. San Diego: Academic Press, 2000.

7. Leng X, Shaw GL, Wright EL. Coding of musical structure and the trion model of cortex. Music Percept 1990;8:49–62.

8. Rauscher FH, Shaw GL, Ky KN. Music and spatial task per- formance. Nature 1993;365:611.

9. Rauscher FH, Shaw GL, Ky KN. Listening to Mozart enhances spatial-temporal reasoning: towards a neurophysiological ba- sis. Neurosci Lett 1995;185:44–7.

10. Hetland L. Listening to music enhances spatial-temporal rea- soning: evidence for the “Mozart effect.” J Aesthetic Educ


11. Johnson JK, Cotman CW, Tasaki CS, Shaw GL. Enhancement of spatial-temporal reasoning after a Mozart listening condition in Alzheimer’s disease: a case study. Neurol Res 1998;20:666–


12. Johnson JK, Shaw GL, Vuong M, Vuong S, Cotman CW. Short- term improvement on a spatial-temporal task after music lis- tening in Alzheimer disease: a group study. Submitted for publication.

13. Hughes JR, Daaboul Y, Fino JJ, Shaw GL. The “Mozart effect”

on epileptiform activity. Clin Electroencephalogr 1998;29:109–


14. Hughes JR, Fino JJ, Melyn MA. Is there a chronic change of the

Mozart effect on epileptiform activity. Clin Electroencephalogr


15. Rauscher FH, Robinson KD, Jens JJ. Improved maze learning through early music exposure in rats. Neurol Res 1998;20:427–


16. Sarnthein J, von Stein A, Rappelsberger P, Petsche H, Rauscher FH, Shaw GL. Persistent patterns of brain activity: an EEG coherence study of the positive effect of music on spatial- temporal reasoning. Neurol Res 1997;19:107–16.

17. Bodner M, Muftuler LT, Nalcioglu O, Shaw GL. fMRI study relevant to the Mozart effect: brain areas involved in spatial- temporal reasoning. Neurol Res 2001;23:683–90.

Letters to the Editor

18. Rauscher FH, Shaw GL, Levine LJ, Wright EL, Dennis WR, Newcomb RL. Music training causes long-term enhance- ment of preschool children’s reasoning. Neurol Res 1997;19:


19. Graziano AB, Peterson M, Shaw GL. Enhanced learning of proportional math through music training and spatial-tempo- ral training. Neurol Res 1999;21:139–52.

20. Leng X, McGrann JV, Shaw GL. Reversal of epileptic state by patterned electrical stimulation suggested by trion model cal- culations. Neurol Res 1992;14:57–61.


To the Editor:

Gordon Shaw is the “father” of the Mozart effect. Coming from the hard science of nuclear physics and retiring from that strict discipline, he became inter- ested in the coding of the brain, choosing music as the root to explore its mysteries. From his own work and those that he inspired, we have now a considerable amount of data that tell us that our performance in many different ways may be enhanced while listening to Mozart music. He has listed in some detail the different types of studies that have been performed while I could only briefly refer to them in my review that featured the effects on epileptiform activity and clinical seizures. My initial introduction to these Mozart studies oc- curred 3 years ago. I was fortunate that my topic at a national meeting was placed immediately after Dr. Shaw’s talk and I was intrigued by this Mozart effect. It is ironic that my topic on that day was to present a review of musicogenic epilepsy. I returned from the meeting with a copy of K.448 that Dr. Shaw gave me, went to work on Monday to find a patient in coma and in status epilepticus, played the Mozart selection, and could hardly believe my eyes when I saw the clear reduction of ictal rhythms. We have Dr. Shaw to thank also for relating this effect to the superorganization of the cerebral cortex, as Mountcastle has demonstrated, both physiologi- cally and anatomically. The superstructure of the

M.I.N.D. Institute Irvine, California 92612


2 To





Gordon L. Shaw 2




Mozart music resonates well with the great organiza- tion of our cortex, especially as is revealed in its on- togeny. Gordon Shaw is more than a theorist, since he has established his own institute which is devoted to im- proving the learning abilities of children using the principles from the Mozart effect. Readers interested in the use of these principles in the classroom should check his “Keeping Mozart in Mind.” I was especially pleased that he included in his letter the description of the newly discovered and fascinat- ing changes in the fMRI that show this particular music is related to distinctive changes that are differ- ent from the changes seen with the music of other well-known composers, like Beethoven. As further work is published, we will likely find “hard” data other than the reduction of seizure activity and the activation of specific brain regions that will be even more convincing that the Mozart effect is an impor- tant, genuine phenomenon.

John R. Hughes, M.D., Ph.D.

Epilepsy Clinic Department of Neurology University of Illinois Medical Center Chicago, Illinois 60612


Active-Control Comparative Equivalency Monotherapy Trials in Epilepsy

To the Editor:

Beydoun and Milling recently addressed the pros and cons of active-control equivalency trials in epi-

lepsy (1). Active-control equivalency trials compare the effects of two treatments that have already been determined to be effective in other types of trials. The effectiveness of these treatments is compared, usually

© 2001 Elsevier Science All rights reserved.