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  • 1. Neurological Disorders of Musicians and Music Randy M. Rosenberg MD FAAN FACP Assistant Adjunct Professor of Neurology Temple School of Medicine Principle Flutist of the Warminster Symphony
  • 2. So what do you hear….? (or What makes something musical?)  Rhythm=segmentation of pulses and their recognition as the beat of the music  Pitch = a frequency of sound  Pitch Contour = variation in intensity, duration and range of pitch=melody  Pitches played together=chords  Two or more pitch contours played together=harmony  Timbre= The same pitch played on two instruments sound different (e.g.piano and sax)
  • 3. ”I like the beat, and you can dance to it. I give it a 85”Rock-a-bye Baby You’re a Grand Old Flag ¾ 2/4Segments of 3 beats Segments of 2 beatsto a measure to a measure
  • 4. Anatomical Localization of Music  Pitch interval, pattern, tonal structure and timbre  Time interval and rhythm  Recognition  Emotion
  • 5. Musician’s Dystonia: Characteristics
  • 6. Musician’s Dystonia Widespread abnormalities detected in non-motor brain regions in functional imaging studies of patients with dystonia (Fabbrini et al., 2011; Kuyper et al., 2011) Proposed phenomenology  Deranged cortical plasticity leading to abnormal sensorimotor integration  Reduced inhibition across several levels of the motor pathway (Chang et al Current Neuropharmacology, Volume 11, Number 1, January 2013 , pp. 41-47(7))
  • 7. Guitarist with Musician’s Dystonia
  • 8. Flutist with Embourchure Dystonia
  • 9. Patterns of Musician’s Dystonia
  • 10. Musician’s Dystonia: Treatment Anticholinergics Baclofen Low dose cabidopa-larodopa Onabotulinium toxin A Sensory Motor Retuning (SMR)
  • 11. Primary Bow Tremor
  • 12. Musculoskeletal and Neuropathic Injury in Musicians
  • 13. Musculoskeletal and Neuropathic Injury in Musicians  Carpal Tunnel Syndrome  Especially in guitar, violin and viola players  Sustained 12th and 13th position on violin  Cubital Tunnel Syndrome (Ulnar neuropathy)  Left hand of violin, viola and guitar players  Thoracic Outlet  Bilateral in flutists  Left sided in violinists  Radial Tunnel Syndrome v lateral epicondylitis
  • 14. Gadgets to Reduce Musculoskeletal Injury
  • 15. Musical Hallucinations 1 Charles Ives, Robert Schumann, Shostakovich Interfere with perception or conversation in a manner that never occurs with normal musical imagery Usually are a reference from the patient’s history of musical exposure or training Characteristics changes over time  Increasingly loud  More intrusive  Expanded repertoire with shorter duration  Patient has limited options for control
  • 16. Musical Hallucinations 2 Can be a manifestation of partial seizures usually of right temporal origin Anatomically widespread when due to structural disease: Temporal lobe, parahippocampal gyrus, dorsal pons Drug induced  Anticonvulsants  Antidepressants  Anesthetics  Opiates  Amandatine Most common among hearing impaired suspected as a cortical release phenomenon.  Female > male  Advanced age NOT earworms Treatment  Gabapentin, quintiapine cochlear implant
  • 17. Musicogenic Epilepsy Reflex epilepsy in response to the psychoacoustic aspects of music Strong correlation to the temporal lobe and a right-sided preponderance Patients often have multiple seizure types  Absence and secondary generalization are often influenced by duration of music  Dejavu and other affective seizures are associated with music that evokes strong memories and preference
  • 18. fMRI During an Induced Musicogenic Seizure During epileptic aura initiated by the stimulus, signal increases were found in the left anterior temporal lobe, and the right gyrus rectus. Because fMRI indicated a cascade of recruitment of the ventral frontal lobes by epileptogenic music, left anterior temporal lobe activity could be secondary to a right gyrus rectus focus, possibly triggered by emotional processing of music.Mórocz I.A., Karni A., Haut S., Lantos G., Liu G. fMRI of Triggerable Aurae in Musicogenic Epilepsy.Neurology. 2003 Feb 25;60(4):705-709. PMID: 12601117
  • 19. Williams Syndrome Characteristic facial morphotype Severe cognitive dysfunction Cardiovascular disease accounts for most cases of early mortality Interest and enthusiasm for music is almost universal along with extreme sociability and loquaciousness Deletion at chromosome band 7q11.23 that involves the elastin gene (ELN)  Detected through fluorescent in situ hybridization (FISH)  1 per 7,500-20,000 births
  • 20. Decibel (Loudness) Comparison Chart
  • 21. Damaging Sound Exposure Whether Music or NoiseFor every 3dBs over 85,permissable exposuretime is cut in half60/60 rule for CD players80/90 rule for MP3players
  • 22. iPod and Damage to Hearing The Fligor Rule (2006) Maximum settings to obtain 50% maximum dosage…  iPod volume at 60% for 120 minutes  Depends on earphone used  Some earphones “isolate” the ear.  Some earphones have different electro-acoustic characteristics. In quiet environment, most people have iPod volumes at 50% but in noisy environments the volume is often 80%. Use isolating headphones!
  • 23. Hearing Loss in Musicians 170,000 professional musicians 60 million+ amateur musicians Percentage with hearing loss  Adult musicians age 27-66 years 61%  Youth musicians age 18-22 years 22%  Child Musicians age 8-12 years 16% Hearing thresholds are generally better in women Progression is slower in women and in menTHIS IS WHY THE PROBLEMS OF MUSICIANS ARE SO IMPORTANT! (IT’S THE NUMBERS STUPID!)
  • 24. Five Factors Affecting Hearing Loss in Musicians  Intensity  Maximum limits for symphony orchestras are achieved at anywhere between 10 and 25 hours per week of playing.  Levels in excess of 85 dBA were measured even during a relatively quiet etude at Canada’s National Ballet with a peak level of 126 dBA.  Duration  “Liking the music”  Stapedial reflex  (Individual factors)
  • 25. AMUSIA"I know only 2 tunes: one of them isYankee Doodle, and the other one isnt." -Ulysses S. Grant Talking about music is like dancing about architecture
  • 26. Amusia I Inability to recognize musical tones or rhythms or to reproduce them. Congenital Amusia  Occurs in 5% of population and is life long  Likely some genetic element  Inability to recognize or reproduce familiar tunes  Impaired ability to judge pitch  Variable severity (some individual find music unpleasant e.g. banging and will avoid whenever possible)  Generally does not affect prosody or the ability to recognize familiar sounds
  • 27. If You Are Amusic…….
  • 28. Amusia II Acquired Amusia  Often Coexists with Aphasia  Can have isolated deficits in melody and rhythm  Expressive  Impaired singing  Impaired ability to play an instrument  Deficit for writing musical notation  Receptive  Inability to read musical notation  Inability to interpret melody  Mixed
  • 29. Thank you for yourattention and mayall of your days be tuneful ones.