OBJECTIVE: Listening to Mozart K.448 has been demonstrated to improve spatial 
task scores, leading to what is known as the Mozart effect. Our previous work 
revealed the positive effects of Mozart K.448 in reducing epileptiform 
discharges in children with epilepsy. However, the mechanism remains unclear. 
parasympathetic activation has been shown to help seizure control in many 
studies. In this study, we investigated the effect of Mozart music on 
epileptiform discharges and autonomic activity.
METHODS: Sixty-four epileptic children with epileptiform discharges were 
included. They all received electroencephalogram and electrocardiogram 
examinations simultaneously before, during, and after listening to Mozart K.448 
or K.545. The total number of epileptiform discharges during each session 
(before, during, and after music) were divided by the duration (in minutes) of 
the session and then compared. Heart rate variability including time and 
frequency domain analysis was used to represent the autonomic function.
RESULTS: The results showed that epileptiform discharges were significantly 
reduced during and right after listening to Mozart music (33.3 ± 31.1% 
reduction, p<0.001, during Mozart K.448 and 38.6 ± 43.3% reduction, p<0.001, 
during Mozart K.545) (28.1 ± 43.2% reduction, p<0.001, after Mozart K.448 and 
46.0 ± 40.5% reduction, p<0.001, after Mozart K.545). No significant difference 
was noticed between the two pieces of music. The reduction was greatest in 
patients with generalized seizures and discharges. Significant increases in 
high-frequency (HF), the square root of the mean squared differences of 
successive RR intervals (RMSSD), the standard deviation of differences between 
adjacent RR intervals (SDSD), and a decrease in mean beats per minute (bpm) were 
found during listening to Mozart music. Most of the patients with reduced 
epileptiform discharges also showed a decreased LF/HF ratio, low-frequency 
normalized units (LF nu), mean bpm, and an increased high-frequency normalized 
units (HF nu).
CONCLUSIONS: Listening to Mozart music decreased epileptiform discharges in 
children with epilepsy. The majority of these patients showed an increase in 
parasympathetic tone during music exposure.
SIGNIFICANCE: Our results suggested that Mozart music stimuli induced 
parasympathetic activation which may be involved in the effect of music in 
reducing epileptiform discharges and the recurrence rate of seizures.