Researchers at Kaohsiung Medical University and other centers in Taiwan studied the long-term effect of listening to Mozart K-448 (Sonata for Two Pianos in D major) on the frequency of epileptiform discharges in children with epilepsy, and analyzed the relationship between the number of epileptiform discharges and foci of origin, epilepsy etiology, age, IQ, and gender. Eighteen children (8 boys, 10 girls; mean age, 7 years 10 months; age range, 7 months to 14 years 4 months) with epilepsy and persistent epileptiform discharges for at least 6 months had seizures well controlled with anticonvulsant drugs. Seizures were focal in 16 (88.9%) and generalized in 2; the etiology was idiopathic in 10 and symptomatic in 8. None had musicogenic epilepsy.
After patients had listened to Mozart K448 for 8 minutes before bedtime for 1, 2, and 6 months, epileptiform discharges significantly decreased by 53.2, 64.4, and 71.6%, respectively (p<0.001), except those with occipital discharges. At 6 months, the average decreases in epileptiform discharges at frontal, central, and temporal locations were 100, 99.1, and 96.6%, respectively, compared to 3.7% for occipital foci. Generalized discharges showed a 97.2% decrease. Patients with normal intelligence and idiopathic epilepsy had greater decreases than those with mental retardation and symptomatic epilepsy. Age and gender had no relation to the Mozart effect. 
COMMENT. The Mozart effect was first observed in college students who showed induction of right frontal and left hemisphere EEG activity and enhancement of visual-spatial-temporal reasoning during and after listening to 10 minutes of the Mozart sonata tape. (Rauscher FH et al. Nature 1993; Sarnthein J et al. Neurol Res 1998). Relaxation tapes and minimalist music had no effect. These investigators also reported long-term enhancement of preschool children’s spatial temporal reasoning during piano keyboard lessons but not computer lessons. Listening to music is also recommended as adjunct therapy in children with ADHD and adults with Parkinsonism or Alzheimer’s disease. The Mozart effect in patients with epilepsy is explained by resonance of the cerebral cortex with the architecture of Mozart’s music. 
The variation in the Mozart response with cerebral localization of the epileptiform discharge may be a manifestation of the functional independence of sub-components of musical expression. The left hemisphere is dominant for rhythm, tune recognition, and pitch perception, while the right hemisphere is involved in timbre or quality of tone perception. The differentiation of pitch requires not only auditory, but also, visual interpretation and mental imagery. Listening to Mozart enhances cortical cerebral activity used in spatial-temporal reasoning . String music (string Mozart 448) with a larger number of higher harmonics than piano Mozart 448 had no effect on epileptiform discharges.