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.
611
REFERENCE
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
doi:10.1006/ebeh.2001.0288
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.
612
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.
REFERENCES
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,
1978:1–50.
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:
229 –58.
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;
82:2364 – 8.
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
2000;34:105– 48.
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 –
72.
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 –
19.
14. Hughes JR, Fino JJ, Melyn MA. Is there a chronic change of the
Mozart effect on epileptiform activity. Clin Electroencephalogr
1999;30:44 –5.
15. Rauscher FH, Robinson KD, Jens JJ. Improved maze learning
through early music exposure in rats. Neurol Res 1998;20:427–
32.
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:
2– 8.
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.
Reply
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
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-
613
Gordon L. Shaw 2
M.I.N.D. Institute
Irvine, California 92612
doi:10.1006/ebeh.2001.0279
2
To whom correspondence should be addressed. E-mail:
gshaw@uci.edu.
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
doi:10.1006/ebeh.2001.0287
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.