Abstracts

Rationale: Interictal epileptiform discharges (IEDs) contribute to cognitive dysfunction in epilepsy. Regardless of whether seizure control is achieved with medication, IEDs frequently persist, causing sleep problems, attention deficits, and memory impairments.

Auditory therapy can reduce intracranial IED burden in epilepsy patients. Our group has previously reported that listening to both Mozart’s Sonata for Two Pianos in D Major (K448) and low gamma frequency (40 Hz) stimulation led to a substantial decrease in IED activity (Quon et al., Epilepsia, 2021). Despite matching for tempo or spectral features or being preferred by the participant, we found that no other musical piece reduced IEDs (Quon et al., Epilepsia, 2021). This work suggested that unique transitions in the musical structure of K448 might contribute to its therapeutic effect, with a recent scalp EEG study indicating that tempo and note density may also be important factors (Ding et al., Epilepsy Behav, 2023).

Our current study leverages intracranial encephalography (iEEG) to validate prior scalp findings and further explore the effect of tempo in K448 on IED reduction.

Methods: To date, 8 patients diagnosed with medication-refractory focal epilepsy undergoing pre-surgical evaluation with stereo-EEG were recruited. Participants were exposed to K448 at the original tempo (136 beats per minute (bpm)), increased tempo (166 bpm), decreased tempo (106 bpm), and a potentially more emotionally engaging contemporary music piece at a similar tempo (Coldplay - Clocks; 132 bpm). Not all participants were exposed to each stimulus.

Electrophysiological data underwent visual inspection by an epileptologist. 2 patients were excluded due to the lack of definite interictal populations or presence of ictal-interictal continuum patterns. Data was preprocessed, and IEDs were identified from all contacts using a convolutional neural network as previously described (Quon et al., Clin Neurophys, 2022). This investigation is ongoing and more patients will be enrolled in the future.

Results: Following our previous findings, we compared IED rates across musical conditions between the initial 30 seconds and the subsequent 30-90 seconds (Figure 1). Coldplay's "Clocks" and the slow tempo K448 showed considerable variation in IED activity across participants. At the original tempo of K448, 2 of 5 patients showed diminished IED rates from 30-90 seconds compared to the initial 30 seconds. With the faster tempo, 3 of 4 patients exhibited reduced IED rates.

Conclusions: Our preliminary results suggest that a higher tempo for K448 may be more beneficial in reducing IED rates than the original. This contrasts with recent findings from a scalp EEG study, which showed that the original tempo of K448 diminished IED activity while its faster rendition had no effect (Ding et al., Epilepsy Behav, 2023). These findings further examine the mechanisms of IED reduction, which may ultimately help develop auditory therapies to alleviate neurocognitive dysfunction in epilepsy.

Funding: T32LM012204