Epilepsili çocuklarda müzik dinletisinin eeg üzerine etkisi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Epilepsi, çocuklarda oldukça sık görülen nörolojik bozukluklardan biridir. Günümüzde öncelikle çeşitli ilaç terapileri ile tedavi edilmeye çalışılsa da, hastaların bir kısmı mevcut antiepileptik ilaç (AEİ) tedavilerine dirençlidir. İlaç dirençli epilepsi tedavisinde cerrahi müdahale, nöromodülasyon, diyet tedavisi, müzik terapisi ve “Mozart Etkisi”, sanat terapisi, yaşam tarzı değişiklikleri, davranışsal müdahaleler ve tıbbi esrar kullanımı gibi pek çok ikincil tedavi seçenekleri uygulanmaktadır. Literatürde müzik terapisi adı altında yapılan çalışmalarda Mozart etkisinin tanımlandığı ve çocuklarda çeşitli çalışmalar yapıldığı görülmektedir; fakat bu çalışmaların sayısı oldukça azdır. Özellikle Mozart’ın “Sonato for two pianos in D major, K448” ile yapılan çalışmalar dikkat çekicidir. Mozart müziği ile birçok müzik çeşidi kıyaslanmış fakat; literatürde Klasik Türk Musikisi/Makam Müziği ile yapılan, hatta doğu müziği ile yapılan herhangi bir çalışma görülmemiştir.
Bu çalışmada, epilepsili çocuklarda müzik dinletisinin elektroensefalografi (EEG) üzerindeki etkisini incelemek istedik. Çalışmamız, Klasik Türk Musikisi/Makam Müziği ile literatürde yapılan ilk çalışmadır. Özellikle Anadolu medeniyetlerinde ve Türk Tıp Tarihinde müzikle tedavilerin çeşitli şekillerde yapıldığı bilinmektedir, bu nedenle; çalışmamızın bu konuda öncü olmasını umuyoruz.
Çocuk Nörolojisi polikliniğimize 01/02/2022 ve 01/08/2022 tarihleri arasında başvurmuş olan, epilepsi tanısı ile takipli, 5-18 yıl yaş arası hastalar prospektif olarak incelendi. Hastanemiz etik kurulundan 2022/3899 sayılı karar ile etik onay alındı. Çalışmaya dahil edilen hastaların yaşı, cinsiyeti, nöbet tipleri, kullandıkları AEİ tedavisi, ne kadar süredir epilepsi hastası oldukları ve en uzun nöbetsiz süreleri kaydedildi. Çalışmada, hastaların rutin takibinde planlanmış olan uyku EEG’leri çekildi. EEG çekimi hastalar uyuduktan sonra başlatıldı. Hastalara önce 5 dakika bazal müziksiz EEG çekildi. Ardından 8 dakika Mozart K448 dinletisi esnasında EEG kaydı alındı. Daha sonra 5 dakika müziksiz EEG çekimi yapıldı (1. ara). Ardından 8 dakika Tanburi Cemil Bey’e ait “Hüseyni Oyun Havası” dinletilerek EEG kaydı alındı, son olarak müziksiz 5 dakika EEG
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çekimi yapılarak (toplam beş bölüm), EEG çekimi sonlandırıldı (son ara). EEG çekimi esnasında dinletilen müziğin şiddeti bir metre mesafeden normal insan konuşma sesi desibeli (dB) olan 58 dB’e ayarlandı, tüm EEG kaydı esnasında standardize edildi. Hastaların çekilmiş olan uyku EEG’leri, aynı Çocuk Nörolojisi uzmanı tarafından değerlendirilerek EEG’lerde mevcut olan diken-dalga kompleksleri sayıldı. Toplam diken-dalga kompleksleri sayısı, saniye cinsinden bölüm süresine bölündü, 100 ile çarpılarak mevcut olan bölümün epileptik aktivite indeksi ( EAİ) % cinsinden hesaplandı. Elde edilen % cinsinden veriler, EAİ olarak adlandırılarak istatiksel analize sunuldu. İstatistiksel analizler için SPSS 27.0 programı kullanıldı ve p<0,05 olması anlamlı kabul edildi.
Çalışmaya on beş hasta alındı. Çalışmaya dâhil edilen on beş hastanın yaş ortalaması 8,73±3,34 yıl, yaş ortancası 8,00 yıl (6,00-9,00 yıl), %66,70’si (n=10) erkek, %33,30’ü (n=5) kız idi. Hastaların %80,00’ı (n=12) jeneralize nöbet, %20,0’si (n=3) fokal nöbet nedeniyle takipli, 40,00’ı (n=6) valproik asit, %33,30’ü (n=5) levetirasetam, %26,70’si (n=4) karbamazepin tedavisi almakta idi. Hastaların ortalama 28,06±28,27 ay, ortanca 12,00 aydır (6,00-60,00 ay) epilepsi hastası olduğu, en uzun nöbetsiz geçirdikleri süre ortalamasının 21,40±17,12 ay, ortancasının 16,00 ay (6,00-32,00 ay) olduğu tespit edildi. Hastalarda nöbetsiz geçen en uzun süre ortancası valproik asit kullananlarda 29,00 ay (9,50-40,50 ay), levetirasetam kullananlarda 24,00 ay (10,50-40,00 ay), karbamazepin kullananlarda 6,00 aydı (4,50-9,00 ay). Hastaların kullandıkları AEİ türüne göre nöbetsiz geçen en uzun süreleri benzer tespit edildi (p=0,067).
Hastaların müzik öncesi bazal EEG’de meydana gelen EAİ ortalaması 13,12±9,67, ortancası 10,60 (4,07-21,20), Mozart müziği sırasında meydana gelen EAİ ortalaması 17,96±13,75, ortancası 16,00 (8,40-24,00), 1. arada meydana gelen EAİ ortalaması 17,87±15,13, ortancası 10,30 (8,20-25,00), Hüseyni Oyun Havası sırasında meydana gelen EAİ ortalaması 13,30±7,30, ortancası 7,30 (3,90-22,70), Hüseyni Oyun Havası sonrasında son arada meydana gelen EAİ ortalaması 9,79±10,40, ortancası 5,50 (1,30-18,90) idi. Hastaların beş bölümde hesaplanan EAİ değerlerinde anlamlı farklılık olduğu saptandı. Farkın, son aradaki EAİ’nin, Mozart dinlenirken ve Mozart sonrasındaki 1. ara dönemde hesaplanan EAİ’nden daha düşük olmasından kaynaklandığı tespit edildi (p=0,002).
Bazal EEG’de hesaplanan EAİ’nin erkek hastalarda ortalaması 11,81±8,93, kız hastalarda ortalaması 15,76±11,63 idi. Mozart dinletilmesi sırasında hesaplanan EAİ’nin ortalaması erkek hastalarda 17,05±15,20, kız hastalarda 19,78±11,60, 1. ara dönemde hesaplanan EAİ’nin ortalaması erkek hastalarda 13,75±9,81, kız hastalarda 26,12±21,39’du. Hüseyni Oyun Havası dinletisi sırasında EAİ ortalamasının erkek
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hastalarda 10,60±8,82, kız hastalarda 18,70±14,47, son aradaki EAİ ortalamasının ise erkek hastalarda 10,37±9,68, kız hastalarda 8,62±12,85 olduğu tespit edildi. Epilepsi hastalarının EEG çekimindeki her bölümde hesaplanan EAİ’nde cinsiyete göre anlamlı farklılık olmadığı saptandı (p=0,174).
Jeneralize nöbeti olan hastaların bazal bölümdeki ortalama EAİ değeri 12,94±10,00, Mozart dinlenirken hesaplanan ortalama EAİ değeri 17,71±14,82, 1. ara dönemde hesaplanan ortalama EAİ değeri, 18,25±16,80, Hüseyni Oyun Havası dinlenirken hesaplanan ortalama EAİ değeri 12,69±11,76, son arada hesaplanan ortalama EAİ değeri 9,35±10,17 idi. Fokal nöbeti olan hastaların bazal bölümdeki ortalama EAİ değeri 13,86±10,20, Mozart dinlenirken hesaplanan ortalama EAİ değeri 18,93±10,63, 1. ara dönemde hesaplanan ortalama EAİ değeri 16,33±6,79, Hüseyni Oyun Havası dinlenirken hesaplanan ortalama EAİ değeri 15,73±10,30, son arada hesaplanan ortalama EAİ değeri 11,52±13,51 idi. Hastaların her bölümde hesaplanan EAİ’nin nöbet türüne göre anlamlı değişim göstermediği belirlendi (p=0,971).
Hastaların bazalde, Mozart sırasında, 1. arada, Hüseyni Oyun Havası sırasında ve son arada hesaplanan EAİ değerlerinin, kullanılan AEİ’a göre de anlamlı farklılık göstermediği saptandı (p=0,772).
Çalışmamızın sonucunda, literatürden farklı olarak hem Mozart müziği hem de Hüseyni Oyun Havası esnasında EEG’lerde bazal müziksiz EEG’lere göre epileptiform aktivitede azalma saptamadık. Bu literatürde bildirilen sonuçlarla çelişiyordu. Bu konuda, daha geniş örneklemlerin ele alındığı, farklı makam müzikleri ile Mozart’ın kıyaslandığı daha kapsamlı çalışmalara ihtiyaç vardır.
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 ix 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). x 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.
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 ix 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). x 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.
Açıklama
Anahtar Kelimeler
Çocuk, Epilepsi, Mozart etkisi, Makam müziği, Epileptik aktivite indeksi, Child, Epilepsy, Mozart effect, Maqam music, Epileptic activity index
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Taşer, M. (2023). Epilepsili çocuklarda müzik dinletisinin eeg üzerine etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
