Neurons in Harmony: Music and the Brain with Phillip Pearl, MD

Many thanks to Phillip Pearl, MD, for joining me on this episode of The Art of Medicine with Dr. Andrew Wilner. Dr. Pearl is a pediatric neurologist and Director of Epilepsy and Clinical Neurophysiology at Boston Children’s Hospital, in Boston, MA. He is also a serious musician and has performed in the Longwood Symphony Orchestra. Dr. Pearl is a member of the Music and Health Institute at the Berklee College of Music. Dr. Pearl’s love of music has even overflowed to his wife, who is now taking piano lessons!

Dr. Pearl’s new book,

Please click "Fanmail" and share your feedback!

If you enjoy an episode, please share with friends and colleagues. "The Art of Medicine with Dr. Andrew Wilner" is now available on Alexa! Just say, "Play podcast The Art of Medicine with Dr. Andrew Wilner!" 

To never miss a program, subscribe at www.andrewwilner.com. 

Follow me on Instagram: @andrewwilnermd

X: @drwilner

linkedin.com/in/drwilner 

Please rate and review each episode. 

To contact Dr. Wilner or to join the mailing list: www.andrewwilner.com

This production has been made possible in part by support from “The Art of Medicine's” wonderful sponsor, Locumstory.com, a resource where providers can get real, unbiased answers about locum tenens. If you are interested in locum tenens, or considering a new full-time position, please go to Locumstory.com.

Or paste this link into your browser:

https://locumstory.com/?source=DSP_directbuy_drwilnerpodcast...

Transcript

[Andrew Wilner, MD] (0:08 - 1:24)

Welcome to the Art of Medicine, the program that explores the arts, business, and clinical aspects of the practice of medicine. I'm your host, Dr. Andrew Wilner. I've planned a great program for today, but first, a word from our sponsor, locumstory.com.

Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. Locumstory answers your questions on their website, podcast, webinars, videos, and they even have a locums 101 crash course.

Learn about locums and get insights from real life physicians, PAs, and NPs at locumstory.com. And now to my guest. Today I have the pleasure of speaking with Dr. Phillip Pearl. Dr. Pearl is Director of Epilepsy and Clinical Neurophysiology at Boston Children's Hospital. He is also a serious musician and has performed in the Longwood Symphony Orchestra. Dr. Pearl is currently a member of the Music and Health Institute at the Berklee College of Music in Boston. Today we're going to discuss how music affects the brain and the potential for music therapy. Dr. Pearl also has a new book that he might tell us about. Welcome Dr. Pearl.

[Phillip Pearl, MD] (1:25 - 1:30)

Oh, thank you very much. It's great to be on here and discuss one of my favorite topics, music and medicine.

[Andrew Wilner, MD] (1:31 - 1:36)

I see you're prepared. You have your music tie. Can we get a better look at that?

What's going on there?

[Phillip Pearl, MD] (1:36 - 1:50)

Yeah. So I think my wife gave me this as a gift at some point. It's got musical instruments on it.

So as I was getting dressed this morning, sometimes you pick a tie based on, you know, the mood or something. Sometimes you don't wear ties, but anyway.

[Andrew Wilner, MD] (1:50 - 1:56)

Now, has she, she has leaned into your musical bent. Is she a musician as well?

[Phillip Pearl, MD] (1:58 - 3:37)

No, actually she's a pediatrician. That's the basis of how we met. So that's a big commonality.

I will say our mutual love for medicine is the spark for that, but she has certainly worked hard to include our children in music and dance and art and in fact is taking piano lessons herself related to research that we probably should be discussing right now because it was research published in the annals of the New York Academy of Medicine a couple of years ago where they took older adults, not that she's older, she's in her mid fifties, but they took older adults 65 and up and they put half of them and these were naive musicians.

They were not musicians. They put half of them in piano lessons and they put half of them in a music appreciation course where they just kind of sat around and listened to music and talked about it. And after six months, they found that the temporal lobes of the adults who took the piano lessons enlarged the superior temporal gyrus, the area of Heschel's gyrus, the primary auditory cortex, enlarged as compared to the half that were put in a music appreciation course.

So the point is that our plasticity is there throughout life. Our brain is very plastic, of course, in the first couple of years of life. That's what developmental neuroscience is all about, but there's even enough plasticity in the brain that in adulthood, you can still benefit by studying music and playing music.

It's that good for your brain.

[Andrew Wilner, MD] (3:38 - 4:06)

Right, and I think, you know, that's, people may not remember, but it was kind of dogma that once you're an adult, the brain doesn't change, right? That's what I was taught. You know, when you're a kid, yes, you've got plasticity, but that it disappears.

And then somebody found that there were like new hippocampal cells somewhere coming up, even if you're old. And now we see that you actually can change the brain even when you're no longer a child.

[Phillip Pearl, MD] (4:06 - 5:18)

You know, it's a funny thing that all of a sudden there's this big, like, brain preservation business. People are actually monetizing all of this thing, and it's gotten crazy. I have to say a sobering aspect, which is the research here at Harvard Medical School, especially led by Dr. Clifford Saper, who just gave grand rounds on this last week, so it's fresh in my head, and he's the former editor of the Annals of Neurology. He's done seminal sleep research, and he's finding that even with normal aging, there's a significant loss of cells in the brain. For example, in the hypothalamus that controls sleep, which is why we sleep less and less as we get older, and it ties into degenerative diseases like Parkinson's and Alzheimer's, and the population is aging, which means dementia is going up. So we have tremendous negative changes in our brain as we get older, and not even as we get older, but it turns out in middle age, in early adulthood, it starts in the 30s and 40s, in the 50s, it starts.

So it's sort of inexorable, and it's a little bit depressing. But on the other hand, as you said, there is also evidence that playing some of these brain games is good for the brain, and can slow down memory loss, and can spark all sorts of things, and that in fact, there is very good scientific evidence that music is among those.

[Andrew Wilner, MD] (5:19 - 5:30)

Right. So what is, well, we're going to start on the premise that there is something special about music, right? And what is it?

Why is music different?

[Phillip Pearl, MD] (5:31 - 9:00)

Well, as a neurologist, I'll say this, there have been studies done, for example, by my colleague here at MIT, Dr. Nancy Kamwisher, where people have studied the effects of music in the brain of epilepsy patients implanted with electrodes. We had the opportunity to study these patients because they're being, you know, invasively studied to treat their epilepsy. And through kind of taking advantage of that situation, neuroscientists have discovered that there are parts of the brain subserving music that are distinct, for example, from language cortex.

And so even though they're very close, they're mainly in the dominant temporal lobe, it's very distinct neuronal populations that are activated during music, whether it's vocal music or just instrumental music, even a drum solo, which some people might argue, is that really music, or is that some sort of rhythmical expression or something like that? All of those areas, vocal music, instrumental music, drum solo, activate in epilepsy patients has been shown certain neurons not activated by language and language activates different neurons. So similar parts of the brain, but the first issue is, music is not just an adaptation of language to something artsy and fancy, it's a totally, although close by, different area of the brain.

The second thing is that the functional MRI studies we now have, as opposed to lesional studies where someone gets a head injury, you do a CAT scan or an MRI, you see where the lesion is. But the functional imaging allows us to have a person function and see what part of their brain is activated. And music in particular activates widespread areas of both hemispheres of the brain, even the cerebellum in the back of the head.

So it's not like music has its particular area, it involves widespread areas of all the lobes and their whole pathways in music, just like vision involves very complex pathways of processing. Music also involves complex pathways that we can get into. And yet it's clear that it has evolved for whatever reason, maybe there were early evolutionary advantages to music like mating with love songs or species use songs to warn of predators coming for survival.

So there are a lot of theories about the evolutionary aspects of music. There's a whole chapter in my upcoming book on how Plato, the ancient Greek philosophers, discussed music. But it's clear in modern neuroscience that music activates very discrete areas of the brain, different from language, so it's a different part of the brain.

It activates widespread areas of the brain on both sides. And it involves what we now view in neuroscience as networks. You know, it used to be, for example, epilepsy was a lesional disorder.

We'd say the lesion is here, the lesion is there. There's a zone that causes the seizure. There's a zone that affects the EEG.

There's a zone of eloquent cortex that you have to spare if you do epilepsy surgery. Now, epilepsy, for example, is viewed as a network disorder, where it's different networks of the brain, where different hubs and spokes are there interacting with each other. All this connectomics is based on our ability of functional MRI to map pathways and use statistical analysis to find these networks.

It turns out that music is involving the very specific networks of the brain, and that classical playing versus improvisational playing actually involves different networks.

[Andrew Wilner, MD] (9:01 - 9:25)

Right. I remember reading that somewhere where they were actually doing functional MRI with musicians, and if the musician played a classical piece, Mozart or Beethoven, that actually looked different than if the musician was spontaneously improvising. In other words, different pathways, many of the same, but many that were different were involved.

I thought that was amazing.

[Phillip Pearl, MD] (9:26 - 11:03)

You're absolutely right. Wow, you are so prepared with this material. It's very impressive.

The wonderful studies have been done using MR-compatible keyboards, which is amazing because you can't put metal in an MRI or things start flying around the room. But MRI-compatible keyboards were made, and so functional MRI has been done with people listening to music or thinking about music, but also with playing music. And while playing music, it turns out that more classical playing seems to activate the more executive function network or more lateral areas of the prefrontal cortex, whereas more improvisational playing seem to activate more of what we call the default mode network, the network that's kind of working in our brain when we're idling or we're just kind of meditating or cogitating or just hanging out. And then more of a relaxation network, more medial prefrontal cortex, also involving areas of the cingulate gyrus and other areas of the brain as well, temporal lobe, angular gyrus back in the parietal lobe. But yeah, different types of playing activate different networks, and it's quite interesting that kind of over-practiced classical memorization playing is the executive function network and more relaxed or improvisational playing or natural playing is the default mode network.

And then there's the salience network, which helps you distinguish what's salient versus what isn't, the signal from the noise problem. And if we get into autism, for example, which is interesting with music because autistic patients or people with autism are often felt to be gifted in music, and it turns out there's some evidence for that. But they had problems with the salience network where they can't filter out the signal from the noise.

[Andrew Wilner, MD] (11:07 - 11:41)

Now, I told you before we started recording that I wasn't going to ask you anything you didn't know, but I do, I'm not sure about this question. Why are some people musical or more musical? For example, yourself, ever since you were a kid, you were musical.

You went to a music conservatory, but your average person just wouldn't survive in music conservatory. They might enjoy listening to music, but clearly their ability, their musical talent is not the same. Do we know where that lives in the brain?

[Phillip Pearl, MD] (11:43 - 12:55)

Well, that's the big question about nature versus nurture. And in fact, when I'm in musical circles, there are people who are way more musical than I am. I can tell you that.

For example, I don't have absolute pitch or perfect pitch, but some people do, which is an amazing thing to me. Most musicians need relative pitch, but not so much absolute pitch. So there's a lot of information on genetics.

And there's a chapter of my book dedicated to the genetics of musicality. It's very clear that musicality is genetic. Absolute pitch runs in families, pitch runs in families, musicianship runs in families.

My father was a professional musician. Right. Not a coincidence, right?

It's not a coincidence. Probably the most important composer in history, Johann Sebastian Bach, had many children. I think he had like 11 children or maybe more, but quite a few of them, I think most of them ended up being professional musicians.

I mean, there's no coincidence to the nature, but the nurture is also very important. In my case, there may be a biologic underpinning, but I was also surrounded by it as a child growing up. So there's nature versus nurture, and both seem to be very important.

Well, let's talk about that.

[Andrew Wilner, MD] (12:55 - 13:20)

The importance of musical education, whether it be learning the great classics or actually learning to play an instrument for children. You're also a pediatrician, so you're very interested in childhood development. You know, all in all, I mean, kids need to eat healthy and exercise and do all those things.

How much difference do you think it makes if they learn to play an instrument or not?

[Phillip Pearl, MD] (13:22 - 13:33)

Oh, it makes a tremendous difference. I've spoken to adults who have perfect pitch. They can sit at a piano, hear something and play it, but they really can't play.

And it's because they never took a lesson.

[Andrew Wilner, MD] (13:33 - 13:34)

Hmm.

[Phillip Pearl, MD] (13:34 - 14:11)

And then there are other musicians who are gifted but never took formal lessons, and it limits them. I've had to talk to many musicians who are very limited because they never learned to read music, or they never learned the classics. So they can play what they can hear, but not perfectly.

And they're very limited. Of course, education without any innate talent is going to be a problem, too. But both are incredibly important.

Both having some innate ability, but also having an education. Or else you will be limited. Absolutely, you'll be limited.

Maybe there's an occasional exception.

[Andrew Wilner, MD] (14:12 - 14:22)

But do you think it spills over to achievement in non-musical areas like math and English and all the other things kids have to learn?

[Phillip Pearl, MD] (14:23 - 15:04)

I do, because there's evidence that children who study music have better academic achievement in non-musical areas. Now, there are a lot of potential confounders. It might be those families are providing those children with all these extra resources.

It might be those children are more motivated or something like that. But the evidence is too strong to refute that an early musical education is associated with success in other areas. And it makes sense, because when your brain is working on learning music, you're working on basically problem solving and puzzle solving and looking at sequences and looking at sound symbol relationships, all the things that go into higher cortical thinking.

[Andrew Wilner, MD] (15:06 - 15:26)

All right, well, let's stretch that to music therapy. Can playing or listening to music help us with any of our, we talked earlier about sort of dementia, you know, diseases, degenerative diseases of the brain. Is music a tool here?

[Phillip Pearl, MD] (15:27 - 17:27)

It is a tool. I would say that we have very good evidence that music therapy helps with more or less immediate and short-term outcomes in a host of neurological diseases. The long-term outcomes are less clear.

The data is not solid to say, for example, there's evidence that music therapy helps children with autism in terms of their social, emotional functionality. But that's kind of in the moment, maybe a brief period afterward. Does it stick?

Does it change the long-term outcome? Does it change their overall severity level? No.

Now, with stroke, for example, and Parkinson's disease, the evidence is the strongest for music therapy, that if someone has a stroke and they're aphasic and cannot speak, especially a motor aphasia, where is the expressive language impaired more than the receptive language, and they really can't get the words out, but they can be taught to sing the words over and over again until they can start to say them again. And the same thing with Parkinson's disease.

They can use music therapy to improve their cadence of gait. There are various ways of music therapy, like using metronome-type repetitive signals or music in general, even playing or listening, where the metronome, for example, is set at a cadence that they can learn to walk at that cadence and force themselves repetitively to walk the cadence so they start walking better. And also there's evidence that music therapy helps upper extremity function with dexterity or just coordination skills with the arms and hands if done to music.

And that evidence is very strong for short-term gains. I think you probably have to stick with the therapy for the gains to continue. I don't think we're at the point of saying you can stop the music therapy and those gains will persist.

[Andrew Wilner, MD] (17:28 - 17:36)

But because of the disease, whatever the pathophysiology of the disease is not really changed by the music, but maybe the symptomatology is improved.

[Phillip Pearl, MD] (17:37 - 17:40)

Exactly. It's rehabilitation. Exactly right.

[Andrew Wilner, MD] (17:40 - 17:53)

Now, in your bio, there was something about participating in the Music and Health Institute at Berkeley, Berkeley, of course, very famous school of music in Boston. Can you tell us what that's all about?

[Phillip Pearl, MD] (17:53 - 18:25)

Berkeley has been successful in collaborating with the many academic institutions in Boston, and they've incorporated several of the medical faculty at Harvard Medical School like myself to participate in courses at Berkeley where I've gone over there and given some lectures on the kind of information we're discussing right now. They have programs and meetings that some of us have been involved in speaking or leading small groups, things like that. So that's what it really is, is trying to bring an awareness of how music figures in to health care.

[Andrew Wilner, MD] (18:27 - 18:44)

I know at some hospitals, there's a sort of a music therapy cart where a music therapist who goes from room to room and plays music with patients, gets them to sing or dance. What do you think about that?

[Phillip Pearl, MD] (18:45 - 19:06)

It's just a wonderful part of the, for example, the child life program at a children's hospital like where I work and children's hospitals all over the country. Programs, for example, if you walk into a lot of children's hospitals these days, you'll see a studio. They call it a secret studio because of the secrets involved in some TV show.

I don't even remember quite the details on that.

[Andrew Wilner, MD] (19:06 - 19:06)

Ah, yes, yes.

[Phillip Pearl, MD] (19:07 - 19:39)

But the kids go in there and make recordings and put on TV shows and do whole programming. It's wonderful rehabilitation for kids in the hospital. It really improves their spirits.

The music therapy is in that same rubric. We actually have started a creative arts program here at Boston Children's Hospital, and the creative arts program is using dance and listening to music and playing music and everything the music therapist can do to help children get through their experience in the hospital.

[Andrew Wilner, MD] (19:41 - 19:49)

Dr. Pearl, I think we've squeezed a lot into the last 20 minutes. Is there anything, I know you got to get back to your patients. Is there anything you'd like to add?

[Phillip Pearl, MD] (19:51 - 20:47)

Well, I appreciate your bringing this to awareness, to attention. It's not just music. All forms of art are really important.

The visual arts and dance and literature and poetry and drama. In fact, there was a study done of actors and actresses, and they did a functional MRI of them reading the script versus improv, and they found that with improvisation with acting, they also activated similar areas to when musicians improvise. So there's a lot of cross-cultural stuff going on here, and it's nice to highlight it because it's just a really important part of humanity and civilization, and we need to keep it going for the kids.

We need to keep it going in the school system. It's kind of the easiest thing to cut when things get rough, but if anything, I think we need to expand it.

[Andrew Wilner, MD] (20:48 - 20:56)

And your book, Music, Medicine, and the Neurobiology of Creativity, I know it's supposed to come out just about now. Is it available?

[Phillip Pearl, MD] (20:57 - 21:17)

It is not yet available. We're still looking at the proofs. The publisher just sent the front matter this week, but we are appreciative of my co-editor Saman Arfeh, who is a neurologist at McGill.

He's actually finishing his residency in Neurology at McGill at the moment.

[Andrew Wilner, MD] (21:17 - 21:22)

As I did many years ago. That's right. As I did many years ago.

[Phillip Pearl, MD] (21:22 - 24:00)

I was giving a virtual Grand Rounds during the pandemic from my desk sitting here, as I'm sitting here talking to you, to the Neurology Department at McGill, and Saman was a medical student then, and he listened to the talk and he asked me some questions about Robert Schumann's pieces, which was very clear that he was a trained classical pianist. And after my talk, he contacted me and he said, basically, he said, I have to work with you. Tell me how I can work with you.

And I do get inquiries from people similar to that. This guy was particularly gifted. And I told him, well, you know, I really would like to, at some point, I've edited a bunch of books.

I've just finished editing Swayman's Pediatric Neurology with Steve Ashwell. That's the major authoritative text in the field. I've written some of my own books.

I really want to do a book on this, but I've never had the time. But maybe if someone young and enthusiastic like you works with me, maybe I'll do it. Well, it's been about five years and the book is about to come out, hopefully next month in March, hopefully at least in the spring of twenty six by Cambridge University Press.

And Simon and I edited together. He actually started a residency in neurosurgery that was so inspired by our work. He switched to neurology.

So he's doing his neurology at McGill, which is a very fantastic place, the MNI, Montreal Neurologic Institute. So you were there. The really that is the historically the Mecca of epilepsy in North America, for sure.

Thanks to the work of Walter Penfield. Yeah, back in the 50s and 60s. So very historic when it comes to epilepsy in the MNI.

So anyway, the book is an amalgamation of authorities in the field writing about aspects like the cerebral processing of music, music and genetics, the serial processing of rhythm, of motor auditory interactions, of bringing other forms of art into medicine. We have chapters on poetry and medicine, art and medicine from authorities in the field. And we also have these medical musical vignettes where the lectures I've been giving where I'll talk about Beethoven's deafness and I'll play Beethoven, Schumann's madness.

I'll play Schumann, Shostakovich's neuropathy. I'll play Shostakovich. Now we have chapters of each of these done like CPCs, clinical pathologic correlations, where we take the clinical and we take the musical and we correlate it in the chapters.

And the book also has links to recordings that I've made with faculty at the Berklee College of Music to exemplify the music of some of the people we discuss in the book.

[Andrew Wilner, MD] (24:01 - 26:44)

Wow, I can't wait to dive in. Thanks so much. Dr. Phillip Pearl, thanks for joining me to discuss music and the brain. It's wonderful. And now a final thanks to our sponsor, LocumStory.com. LocumStory.com is a free, unbiased educational resource about locum tenens. It's not an agency. LocumStory exists to answer your questions about the how-tos of locums on their website, podcast, webinars and videos. They even have a locums 101 crash course.

At LocumStory.com, you can discover if locum tenens make sense for you and your career goals. What makes LocumStory.com unique is that it's a peer-to-peer platform with real physicians sharing their experiences and stories, both the good and bad, about working locum tenens. Hence the name LocumStory.

LocumStory.com is a self-service tool that you can explore at your own pace with no pressure or obligation. It's completely free. Thanks again to LocumStory.com for sponsoring this episode of the Art of Medicine. I'm Dr. Andrew Wilner. See you next time. This program is hosted, edited and produced by Andrew Wilner, MD, FACP, FAAN.

Guests receive no financial compensation for their appearance on the Art of Medicine. Andrew Wilner, MD, is a professor of neurology at the University of Tennessee Health Science Center in Memphis, Tennessee. Views, thoughts and opinions expressed on this program belong solely to Dr. Wilner and his guests and not necessarily to their employers, organizations, other group or individual. While this program intends to be informative, it is meant for entertainment purposes only. The Art of Medicine does not offer professional, financial, legal or medical advice. Dr. Wilner and his guests assume no responsibility or liability for any damages, financial or otherwise, that arise in connection with consuming this program's content. Thanks for watching. For more episodes of the Art of Medicine, please follow on YouTube or your favorite podcast player. Please share with your friends and subscribe.

www.andrewWilner.com