Parasympathetic activation is involved in reducing epileptiform discharges when listening to Mozart music Lung-Chang Lin a,b , Ching-Tai Chiang c , Mei-Wen Lee d , Hin-Kiu Mok e , Yi-Hsin Yang f,g , Hui-Chuan Wu b , Chin-Lin Tsai h , Rei-Cheng Yang b,⇑ a Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan b Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan c Department of Computer and Communication, National Pingtung Institute of Commerce, Pingtung, Taiwan d Department of Music, National Sun Yat-Sen University, Kaohsiung, Taiwan e Institute of Marine Biology, National Sun Yat-Sen University, Kaohsiung, Taiwanz f School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung City, Taiwan g Division of Statistical Analysis, Department of Clinical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan h Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan article info Article history: Accepted 27 February 2013 Available online 27 March 2013 Keywords: Mozart music Epileptiform discharges Parasympathetic activation highlights  Listening to Mozart’s K.448 and K.545 reduced epileptiform discharges in epileptic children.  Heart rate variability analysis showed parasympathetic activation, significant increases in parasympa- thetic parameters, and a decrease in mean heart rate during listening to Mozart music.  The results suggested that Mozart music stimuli induced parasympathetic activation which may be involved in the effect of music on epilepsy. abstract 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. parasympa- thetic 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 elec- troencephalogram 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% reduc- tion, 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. Sig- nificant 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 nor- malized 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. 1388-2457/$36.00 Ó 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.clinph.2013.02.021 ⇑ Corresponding author. Address: Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, #100, Tzu-you 1st Road, Kaohsiung City 807, Taiwan. Tel.: +886 7 3121101x2244; fax: +886 7 3234687. E-mail address: rechya@kmu.edu.tw (R.-C. Yang). Clinical Neurophysiology 124 (2013) 1528–1535 Contents lists available at SciVerse ScienceDirect Clinical Neurophysiology journal homepage: www.elsevier.com/locate/clinph