Humanities in Medicine

For Parkinson’s Disease, Strike Up the Band Continued

which is subtracted from the scan. So, if activity is equally increased in both of those parameters, we will see gray – which could seem to indicate that nothing is going on, but that’s therefore not necessarily the case. (Don’t fret over this.)

Using a few representative slices of brain, what follows is an “executive summary” of multiple MRI images taken for the three parts of the study.

In Fig 1a, listening to the bylaws and subtracting listening to music, somewhat surprising is my auditory cortex lighting up with the bylaws reading (red outline), but no emoting, as opposed to Fig 1b, in music listening fMRI where we see much emotional activity (yellow outline), but no activity in the auditory cortex. (I was obviously intensely engaged by my wife’s rendition of the bylaws.)

In listening to the bylaws and subtracting thinking about music (Fig 2a), the music is silent, so this time we expect (and see) substantial uptake in the auditory cortex (outlined in red) and an absence of emoting.

In Fig 2b mental music produces no auditory uptake, but leads to striking emoting (outlined in yellow) and brain stem activity (outlined in green). The brain stem (most prominent uptake of which is in the pons) includes pathways exiting the brain to activate motor activities in the body.

Fig 3

In Fig 3a, listening to music, as expected, lights up the auditory cortex (outlined in red), but in Fig 3b with thinking, we see executive decisions flying (outlined in blue), as well as much emoting activity outlined in red. This activity took place in the right basal ganglia, the parietooccipital regions, the cerebellum, and all sorts of non-specific areas, including the visual cortex. The brainstem outlined in green is prominent.

It seems that no matter what the parameter, the pons lights up with mental music. Is my brain directing my fingers to start working, and am I “visualizing” the keyboard and/or the score? This (finally) gets to my question about mental music impacting so dramatically on gait – probably more than external cueing, which in its own right is so impressive. Is this because of activation of the brainstem (corticospinal tract), and would this be an area worth further study?

The medical literature most often leaves the human side of interventions to our imagination, since the hard objectivity of p values is unlikely to activate our brains’ emotional centers. About six years ago I diagnosed my brother-in-law, Gary, with PD. In the last year or so he has struggled. I was unable to find a music therapist in his home country of the Philippines, but my niece found a dance instructor whose enthusiasm and skills are infectious, and he put together a wonderful program on the fly.

So, allow me to introduce you – with their permission – to Gary, music/dance therapist Jaypee, and home aide Glenda. By spending eight minutes watching this video, I think you will experience a valuable human side to this story.

In conclusion, MT improves mobility, balance, voice, speech processing, anxiety, fatigue, depression, socialization, and more. Unfortunately, impressive functional gains are not maintained if therapy is discontinued. The hope for our PD patients is that our medical colleagues will more actively write prescriptions for music therapy, importantly coordinated by a skilled music therapist.

Luana Katlen da Silva et al. (5) astutely recommends this take-home message for our patients: “Never stop the music.” I think we should certainly consider this advice. +

References

1. Costa, H.N., Esteves, A.R., Empadinhas, N., et al. Parkinson›s Disease: A Multisystem Disorder. Neurosci. Bull. 39, (2023) 113–124

2. Sotomayor, Manuel Joaquín Machado, ArufeGiráldez, Víctor, et al. Music Therapy and Parkinson’s Disease: A Systematic Review from 2015–2020. Int. J. Environ. Res. Public Health 2021, 18, pp. 01-16.

3. Calabrò, Rocco Salvatore et al. Walking to your right music: a randomized controlled trial on the novel use of treadmill plus music in Parkinson’s disease. Journal of NeuroEngineering and Rehabilitation (2019) 16:68.

4. Zhou, Zonglei, Zhou, Ruzhen et al. Effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life for patients with Parkinson’s disease: A systematic review and metaanalysis. Clinical Rehabilitation (2021). Vol. 35(7) 937–951.