Epilepsili çocuklarda müzik dinletisinin EEG üzerine etkisi

Epilepsy is one of the most common neurological disorders in children. Although it is tried to be treated with various drug therapies today, some of the patients are resistant to current antiepileptic drug (AED) treatments. In the treatment of drug-resistant epilepsy, many secondary treatment options such as surgery, neuromodulation, diet therapy, music therapy and the "Mozart Effect", art therapy, lifestyle changes, behavioral interventions and medical cannabis use are applied. In the literature, it is seen that the Mozart effect has been defined in studies conducted under the name of music therapy and various studies have been carried out on children; but the number of these studies is very small. Especially the works with Mozart's "Sonato for two pianos in D major, K448" are remarkable. Mozart music and many types of music were compared but; In the literature, there has not been any study made with Classical Turkish Music/Maqam Music, or even with Eastern music.In this study, we wanted to examine the effect of listening to music on electroencephalogram (EEG) in children with epilepsy. Our study is the first study in the literature with Classical Turkish Music/Maqam Music. Especially in Anatolian civilizations and Turkish Medicine History, it is known that treatments with music are done in various ways, therefore; we hope that our work will lead to this. Patients aged 5-18 years, who applied to our Pediatric Neurology outpatient clinic between 01/02/2022 and 01/08/2022, were followed up with the diagnosis of epilepsy, were prospectively analyzed. Ethical approval was obtained from the ethics committee of our hospital with the decision numbered 2022/3899. The age, gender, seizure types, AED treatment they used, how long they had epilepsy, and the longest seizure-free period of the patients included in the study were recorded. In the study, sleep EEGs, which were planned in the routine follow-up of the patients, were taken. EEG recording was started after the patients slept. A baseline EEG was taken for 5 minutes without music. Then, EEG recording was taken during Mozart K448 for 8 minutes. Then, 5 minutes of EEG recording was done without music (1st interval). Then, EEG recording was taken by listening to "Hüseyni Oyun Havası" by Tanburi Cemil Bey for 8 minutes, and finally, EEG recording was made for 5 minutes without music (last interval) and the EEG recording was terminated (five episodes in total). The intensity of the music played during EEG recording was adjusted to 58 dB, which is the normal human speech sound decibel (dB) from one meter away, and it was standardized during the entire EEG recording. The sleep EEGs of the patients were evaluated by the same Pediatric Neurology specialist and the spike-wave complexes present in the EEGs were carefully counted. The total number of spike-wave complexes was divided by the duration of the episode in seconds, multiplied by 100 to calculate the epileptic activity index (spike-wave index, EAI) of the present section in %. The obtained data in % were named as EAI and presented for statistical analysis. SPSS 27.0 program was used for statistical analysis and p<0.05 was considered significant. Fifteen patients were included in the study. Mean age of the fifteen patients included in the study was 8.73±3.34 years, median age was 8.00 years (6.00-9.00 years), 66.70% (n=10) were male, 33.30% (n=5) were girls. 80.00% (n=12) of the patients were followed up due to generalized seizures, 20.00% (n=3) focal seizures; 40.00% (n=6) valproic acid, 33.30% (n=5) were receiving levetiracetam and 26.70% (n=4) were receiving carbamazepine treatment. The patients had epilepsy for a mean of 28.06±28.27 months, a median of 12.00 months (6.00-60.00 months), the longest seizure-free time was 21.40±17.12 months, the median was 16.00 months (6,00-32.00 months) were determined. The median duration of seizure-free time was 29.00 months (9.50-40.50 months) in patients using valproic acid, 24.00 months (10.50-40.00 months) in patients using levetiracetam, 6.00 months (4.50- 9.00 months) in patients using carbamazepine. The longest seizure-free periods were found to be similar according to the type of AED used by the patients (p=0.067). The mean EAI occurred in the basal EEG before the music of the patients was 13.12±9.67, the median was 10.60 (4.07-21.20), the mean EAI occurred during Mozart music was 17.96±13.75, the median of 16.00 (8.40-24.00), the mean EAI that occurred in the 1st interval was 17.87±15.13, the median was 10.30 (8.20-25.00), which occurred during the Hüseyni Oyun Havasi. The mean EAI at the last interval after Hüseyni Oyun Havasi is 13.30±7.30, the median is 7.30 (3.90-22.70), the mean EAI at last interval is 9.79±10.40, the median is 5.50 (1.30-18.90). It was determined that there was a significant difference in the EAI values calculated in the five sections of the patients. It was determined that the difference was due to the fact that the EAI at the last interval was lower than the EAI calculated while Mozart was resting and in the 1st interval after Mozart (p=0.002). The mean EAI calculated in the baseline EEG was 11.81±8.93 in male patients and 15.76±11.63 in female patients. The mean EAI calculated during listening to Mozart was 17.05±15.20 in male patients and 19.78±11.60 in female patients. The mean EAI calculated in the 1st interval was 13.75±9.81 in male patients and 26.12±21.39 in female patients. During Hüseyni Oyun Havasi, the mean EAI was found to be 10.60±8.82 in male patients and 18.70±14.47 in female patients. The mean EAI at the last interval was found to be 10.37±9.68 in male patients and 8.62±12.85 in female patients. It was determined that there was no significant difference according to gender in the EAI calculated in each section of the EEG of epilepsy patients (p=0.174). The mean EAI value in the baseline section of the patients with generalized seizures was 12.94±10.00, the mean EAI value calculated during Mozart was 17.71±14.82, and the mean EAI value calculated in the 1st interval was 18.25±16.80. The mean EAI value calculated during Hüseyni Oyun Havasi was 12.69±11.76, and the mean EAI value calculated at the last interval was 9.35±10.17. The mean EAI value in the basal section of the patients with focal seizures was 13.86±10.20, the mean EAI value calculated during Mozart was 18.93±10.63, the mean EAI value calculated during the 1st interval was 16.33±6.79, the mean EAI value calculated during Hüseyni Oyun Havasi was 15.73±10.30, mean EAI value calculated for the last interval was 11.52±13.51. It was determined that the EAI calculated in each section of the patients did not show a significant change according to the seizure type (p=0.971). It was determined that the EAI values of the patients at baseline, during Mozart, in 1st interval, during Hüseyni Oyun Havasi and at the last interval did not differ significantly according to antiepileptic drug used (p=0.772). As a result of our study, unlike the literature, we did not detect a decrease in epileptiform activity in EEGs during both Mozart music and Hüseyni Oyun Havası compared to EEGs without basal music. This was inconsistent with results reported in the literature. In this regard, there is a need for more comprehensive studies that deal with larger samples and compare different maqam music and Mozart.