Why Mozart, Not Beethoven? How Music Influences Seizure Control in Epilepsy
- Dec 18, 2025
- 4 min read
Of the one percent of the global population with Epilepsy, one-third suffer from medication-resistant Epilepsy. Current medications for the disability have minimal benefits on seizure frequency. In the past, I've looked into the positive impacts of music on various disabilities, including Autism, Auditory Processing Disorder, and Dyslexia. I wanted to investigate if music can decrease the number of seizures an individual with Epilepsy experiences. Since loud noises can trigger seizures for some individuals, I thought music, at least some types (such as rock), may also be a trigger. Interestingly, I found that one particular piece of music is very effective at reducing seizure frequency in individuals with Epilepsy by calming neurological stress pathways.
The Famous Mozart Example:
The Mozart Sonata for 2 Pianos K448 is probably the most famous example of music intervention for Epilepsy. Neurological studies have used this musical work to analyze the effects of music on intracranial interictal epileptiform discharges (IEDs), commonly known as seizures. The original research study played the piece for patients with Epilepsy for 90 seconds. During this period, IED rates decreased significantly, particularly in the bilateral frontal regions of the brain.
This decrease in IED rates by the “Mozart Sonata for 2 Pianos K448” is known as “the Mozart effect.” It's unknown why this occurs, but notably, Mozart’s “Sonata for 2 Pianos K448” is among the few pieces that result in such a drastic decrease in IED rates; in fact, of the few pieces shown to have significant benefit, most are by Mozart. For example, Mozart’s Piano Sonata in C Major, K. 545, also exhibits a similar IED reduction rate to K. 448. Still, studies using Beethoven’s “Für Elise” have found almost no changes in seizure reduction at all.
From a pianist’s perspective, I suspect the reason for the difference in seizure reduction is likely the mood and structural differences between Mozart’s “Sonata for 2 Pianos K448” and Beethoven’s “Für Elise.” The Mozart sonata gives off a lively and light feel. In contrast, Für Elise is much more melancholy and nostalgic. Since distress is often a trigger for epileptic seizures, a melancholy or sad mood prompted by a sad song might act as a distress signal in the brain. In addition, the phrase structure of Für Elise is inconsistent, unlike the Mozart sonata. Beethoven frequently employs phrase extensions in his piece, creating an asymmetrical phrasing and rhythmic structure. However, the Mozart sonata does not use these extensions, therefore creating a symmetrical structure throughout the piece. The brain may require fewer signals to process symmetry, thereby reducing the risk of neuronal hyperexcitation.
However, the exact neural mechanisms underlying Mozart intervention are not fully understood; current research indicates that the benefit is indirect and involves emotional pathways that reduce epileptic activity. These pathways are sequences of connections the brain uses to stimulate emotions. Let’s take a look at the two main pathways and how music can influence them to reduce epileptic activity:
Pathway #1:
The auditory cortex processes auditory information and has direct connections with the amygdala, which is involved in emotional regulation and processing. When the ear detects a sound, a signal is transmitted from the auditory cortex to the amygdala, thereby eliciting emotional responses. The hippocampus stores memory, therefore linking the specific sound to a particular emotion.
When the auditory cortex integrates this pathway with the prefrontal cortex and the mesolimbic system, dopamine is released in varying amounts depending on the emotion elicited. This upregulates, or increases the amount of, the emotion throughout the brain.
When some defect or misconnection occurs in this pathway, neurons may become hyperexcited, leading to a seizure.
Music’s Role: It stabilizes this pathway, thereby preventing neuronal hyperexcitation. Classical music, such as the “Mozart Sonata for 2 Pianos K448,” which features slow, calming sections, increases GABAergic inhibition in the brain, thereby inhibiting neuronal hyperexcitation.
Pathway #2:
The amygdala is also interconnected with the very sensitive hippocampal–prefrontal cortex (H-PFC) pathway, signals from the H-PFC pathway and dopamine trigger NMDA receptors. When stress signals are present in the amygdala, the signals can trigger the very sensitive pathway to become hyperexcitable, possibly leading to seizures.
Music’s Role: Music stimulates positive emotions in the amygdala. Therefore, this prevents hyperexcitation of the sensitive pathway and thereby prevents seizures.
While classical music presents benefits for most individuals with Epilepsy, there is a rare type of Epilepsy called Musicogenic Epilepsy. In this form of Epilepsy, music is actually a trigger for seizures in the brain. Therefore, unfortunately, listening to music is likely not an effective therapy for these individuals.
Looking at the neuroscience behind the connection between music and Epilepsy, I think music should absolutely be used to treat all individuals with Epilepsy who can safely listen to music. Unlike medications, music does not have any adverse side effects on the body, making it appeal to individuals with Epilepsy even more, given that available medicines are not very effective. To achieve widespread use of music therapy for individuals with Epilepsy, more research needs to be done analyzing the mechanisms behind music’s beneficial role for individuals with Epilepsy.
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