This document discusses several neurological disorders related to music and musicians. It begins by defining some key musical elements like rhythm, pitch, timbre, and harmony. It then discusses several specific disorders including musician's dystonia, embouchure dystonia, bow tremor, and various injuries musicians may sustain. The document also covers musical hallucinations, musicogenic epilepsy, and Williams Syndrome. Finally, it discusses topics like noise-induced hearing loss, amusia, and treatments for some of the disorders mentioned.

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 2/4
Segments of 3 beats Segments of 2 beats
to 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

21. Decibel (Loudness) Comparison Chart

22. Damaging Sound Exposure Whether
Music or Noise
For every 3dBs over 85,
permissable exposure
time is cut in half
60/60 rule for CD players
80/90 rule for MP3
players

23. 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!

24. 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 men
THIS IS WHY THE PROBLEMS OF MUSICIANS ARE
SO IMPORTANT! (IT’S THE NUMBERS STUPID!)

25. 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)

28. AMUSIA
"I know only 2 tunes: one of them is
'Yankee Doodle', and the other one isn't." -
Ulysses S. Grant
Talking about music is like dancing
about architecture

29. 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

30. If You Are Amusic…….

31. 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

32. Thank you for your
attention and may
all of your days be
tuneful ones.