The Possibility of Using Audio Therapy of A. Tomatis in Treatment of Epilepsy

Kon'shina Natal'ya Vladimirovna ORCID: 0000-0001-7325-3461 PhD in Medicine Epileptologist, Doctor of Functional Diagnostics, Children's Neurological Clinic "Prognoz" 191015, Russia, Leningrad region, St. Petersburg, 3, Paradnaya str., building 2 nata-konshina@yandex.ru Efimova Viktoriya Leonidovna ORCID: 0000-0001-7029-9317 Doctor of Psychology Lecturer, Department of Age Pedagogy and Family Psychology, Russian State Pedagogical University. A.I. Herzen 198218, Russia, Leningrad region, St. Petersburg, St. Nab. Moika River, 48 prefish@ya.ru Efimov Igor' Olegovich ORCID: 0009-0003-4004-5369 Chief Physician of the Medical Center "Doctrine" 197183, Russia, Leningrad region, Saint Petersburg, Kolomyazhsky Prospekt str., 33 9343404@mail.ru

Mazurova Irina Sergeevna ORCID: 0000-0001-5908-3216 Psychologist, Prognoz LLC 191014, Russia, Leningrad region, Saint Petersburg, 3 Paradnaya str., Building 2 irina.1998list.ru@yandex.ru Other publications by this author

IntroductionA person's ability to process auditory and vestibular information is crucial for learning and interacting with the environment.

Therefore, music is widely used as an aid in rehabilitation classes with children and adults with various pathologies and dysfunctions of the nervous system.

Since the middle of the twentieth century, hardware audio trainings based on the method of French otolaryngologist Professor Alfred Tomatis have been developed and used ^[20]. The training consists in listening to the music of Mozart and other composers with the help of special acoustic equipment that filters the sound material, "cutting out" the sounds of certain frequency ranges. Sessions with a microphone and voice are also held. The use of sophisticated acoustic equipment allows you to modulate the work of the auditory and vestibular systems.  The results of experimental studies have been published confirming the positive effect of A.Tomatis training on the condition and learning ability of children and adults with various disorders of the nervous system ^{[2,3,4,6,7,8,13,16,21]}.

However, at the moment, the number of randomized studies confirming the effectiveness of hardware audio therapy is insufficient ^[19].

Heterogeneity of samples, limitation of placebo use for ethical reasons, as well as the variety of equipment used for audio training in different countries complicates the conduct of controlled randomized trials, so it is unlikely that such studies will appear.  It should be noted that randomized studies proving the ineffectiveness or danger of audio trainings are also absent.  Various types of audit trainings based on the method of A. Tomatis are used all over the world to work with children and adults with speech disorders, autism spectrum disorder (ASD), genetic disorders and other developmental disorders.

According to the results of the evaluation of acoustic stem evoked potentials (ASVP) before and after audio training using the method of A.Tomatis, a decrease in the time of bioelectric impulses along the auditory tracts of the brain stem was shown, indicating an improvement in the processes of myelination ^[5].

There is a group of children for whom safety in the use of rehabilitation techniques is especially relevant – these are patients with epilepsy.  For such children, all methods that normalize motor and cognitive development are also relevant, but specialists often have concerns that as a result of their actions, the child's health condition may worsen. 

The presence of certain diagnoses in a child, for example, ASD increases the likelihood of epilepsy ^{[1,9,10,11,17,22]}.

However, such children more than others need instrumental techniques that modulate the work of the nervous system, since they usually have a progressive developmental delay, which is aggravated due to limitations associated with pathological electrical activity of the brain.

The relevance of the study is determined by the fact that the combination of epileptic changes on the EEG, epileptic seizures and developmental disorders in children is a common problem. Most rehabilitation methods aimed at improving development have limitations for children with epilepsy. At the same time, these limitations are not always justified due to the lack of convincing data and a small number of scientific studies. Classroom methods of brain modulation are an urgent direction in the rehabilitation of children with impaired development, however, the safety of this method in children with epilepsy or epileptic changes on the EEG has not been sufficiently studied.

All this determined the purpose of the study: to assess the dynamics of electroencephalographic parameters in children with epilepsy and /or epileptic changes and concomitant developmental disorders during and after audio training by the method of A. Tomatis.

Methods and organization of researchThe study involved 820 children aged 2.5 to 6.5 years.

73.5% (602 people) registered subclinical epileptiform changes on the EEG, and 26.5% (218 people) were diagnosed with epilepsy. At the time of rehabilitation, 62.5% of children were being treated with anticonvulsants. The study was conducted from 2018 to 2022 on the basis of children's neurological clinics "Prognosis" and "Doctrine" (St. Petersburg).

The criterion for inclusion in the clinical group was a combination of epilepsy and/or epileptic changes on the EEG with developmental disorders: F84.0 - RAS, F83.0 - mixed specific developmental disorders; F80.2 - receptive language development disorder. Inclusion criteria were established based on the results of night video EEG monitoring followed by consultation with an epileptologist.  Exclusion criteria: pharmacoresistant forms of epilepsy, frequent epileptic seizures, history of epileptic statuses. These children were not included in the study group, as they were recommended by an epileptologist to correct the therapy of the underlying disease (epilepsy).  

The eight-hour nighttime video EEG monitoring was performed on the Nicolet video EEG monitoring system, the international "10-20" electrode overlay system was used using additional electrodes: ECG. 

The rehabilitation course, including the training of A. Tomatis, lasted 15 days. Before the course, all children underwent neurological examination, functional diagnostics, attended consultations with a speech therapist and a neurologist. Audio training was carried out according to the appointment of a neurologist.

The audio training program was compiled individually based on the diagnostic results.  Audio training by the method of A. Tomatis was carried out on the equipment of Besson of Switzerland (Switzerland).

Monitoring of electroencephalographic parameters was carried out using a wireless outpatient EEG recorder (NEURON-SPECTRUM-CM, "Neurosoft") before audio training, during training and after them.  The international "10-20" electrode overlay system was used.  The index of activity of epileptiform changes from background rhythmics was taken as an evaluation indicator. During the course, EEG monitoring was carried out 4 times within 60 minutes. The control days corresponded to the days of changing frequency filters in accordance with individual audio training programs.   

Results and discussion: It was found that 80.3% of the subjects had stable EEG indicators before, during and after audio training using the A.Tomatis method.

  Figure 1 shows an example of the EEG of the subject N., age 4.5 years, diagnosis of ASD. Epileptiform changes are registered for about 2 years, does not take anticonvulsants, there were no seizures.

Figure 1 EEG of the subject N. (4.5 years) before audio training

Fig. 1. EEG sample from a 4,5-year-old participant N. before audio training.

Figure 2 shows the EEG readings of the same child that were recorded when listening to Mozart's music using an 8000 Hz filter.  The EEG condition is stable.

Figure 2 EEG of the subject N. (4.5 years) during audio training, the EEG condition is stable. 

Fig. 2. EEG sample from a 4,5-year-old participant N. during audio training – stable condition.

11.5% of children had a decrease in the index of representation of epileptiform changes during and after audio training by the method of A.Tomatis.  Figure 3 shows the EEG parameters of the subject C. before audio training. The age of the child is 6 years old, the diagnosis of ASD, epileptiform changes were detected for the first time, he does not take anticonvulsants, there were no seizures.

Figure 3. EEG of the subject C. (6 years old) before audio training

Fig. 3. EEG sample from a 6-year-old participant S. before audio training.

Figure 4 shows the data of the same child that was recorded when listening to Mozart's music using a 0-4000 Hz filter. There is positive dynamics on the EEG.

Figure 4 EEG of the subject C. (6 years old) during audio training – positive dynamics.

Fig. 4. EEG sample from a 6-year-old participant S. during audio training – positive changes.

         8.2% of children had a tendency to deterioration of EEG indicators. This group of children could not complete the rehabilitation course to the end, audio training was canceled for them.  Figure 5 shows an example of the EEG of the subject R. Before audio training.  The age of the child is 3.5 years, the diagnosis of ASD. Epileptiform changes are registered for about 6 months, does not take anticonvulsants, there were no seizures.

Figure 5. EEG of the subject R. (3.5 years) before audio training

Fig. 5. EEG sample from a 3,5-year-old participant R. before audio training.

         Figure 6 shows the EEG indicators of the same child when listening to Mozart music with a 250-6000 Hz filter. There is negative dynamics on the EEG, the child was removed from the course.

Figure 6 EEG of the subject R. (3.5 years old) during audio training – negative dynamics.

Fig. 6. EEG sample from a 3,5-year-old participant R. during audio training - negative dynamic.

Based on the results obtained , the following conclusions were made:

1. Audio training according to the method of A. Tomatis does not significantly aggravate the electroencephalographic picture and can be used in rehabilitation in children with epileptiform disorders and epilepsy.

2. When choosing rehabilitation methods for children with developmental disorders and concomitant epileptiform disorders, an individual approach is necessary.

3. Taking into account the capabilities of modern electroencephalographs, for greater safety of children with concomitant epileptiform disorders, it is recommended to conduct audio training using the A. Tomatis method under EEG control.  The data obtained by us generally correlate with the previously published research results of other authors.

The peculiarity of our study was that children took part in it.  Most often, such studies were conducted with the participation of adult patients with a drug-resistant form of epilepsy ^[15].

In one of the controlled randomized studies, the effect of daily listening to Mozart's music on the frequency of epileptic seizures was evaluated. For three months, the patients listened to Mozart's music, then for three months other music. A statistically significant decrease in the number of seizures during the period of listening to Mozart was revealed, which was not observed during the control period ^[18].

However, the method of A. Tomatis is not limited to listening to Mozart's music, during the training the music is acoustically modified. Published the results of a study that examined the relationship of listening to Mozart's music with the number of seizures, sleep disorders and behavioral disorders in 11 patients (average age 11.9 years) with drug-resistant epilepsy. All patients had severe mental retardation and cerebral palsy. For 15 days, everyone listened to Mozart's music for two hours every day, which was filtered by a device preferably providing higher sound frequencies (>3000 Hz) in accordance with the principles of A. Tomatis. Antiepileptic drug therapy remained unchanged throughout the study period. During 15-day music therapy, the number of seizures decreased by 50-75% in two patients, by 75-89% in three, and by 45.4% in five. Thus, the total number of seizures decreased by ?50%. The decrease in the total number of seizures compared to the baseline level during therapy was 51.5% and 20.7% within two weeks after the end of therapy. All respondents also had an improvement in night sleep and daytime behavior ^[14].

It was proposed to use electroencephalography as a quantitative predictive biomarker of the effectiveness of listening to Mozart's music by the frequency of epileptic discharges and the frequency of background rhythm (BRF) ^[12].

Conclusion.Thus, based on the results of the EEG dynamics assessment, we were able to establish that the inclusion of audio training using the Tomatis method in a comprehensive course of classes with children with developmental disorders and the diagnosis of epilepsy or epileptiform changes can lead to three different outcomes: no changes in the EEG, deterioration of EEG indicators, improvement of EEG indicators.

The majority of children had no deterioration of electroencephalographic parameters during and after audio training by the method of A. Tomatis.  The results of our experimental study show that A. Tomatis training can be used to modulate the work of the auditory and vestibular systems in children with developmental disorders, even in the presence of epileptic changes on the EEG under the following conditions: preliminary examination of the child by an epileptologist, preparation of an individual training program, EEG monitoring during training.