Article In Brief
A neurologist with a lifelong passion for music integrates the art into his work with patients with movement disorders.
Sometimes it's “Old McDonald,” sometimes it's Beethoven or Bach, but music is embedded into everyday life for Alexander Pantelyat, MD, director of the Atypical Parkinsonism Center at Johns Hopkins Medicine, assistant professor of neurology at Johns Hopkins University School of Medicine, and co-director of its Movement Disorders Fellowship program. That includes his working hours as co-founder and co-director of the Johns Hopkins Center for Music & Medicine, and his work to support the creation of a new medical subspecialty: musicians' medicine.
Whether on or off the job, music has been a mainstay of his life from an early age when he first picked up the violin at 7.
Dr. Pantelyat talked to Neurology Today about how he brings his passion for music performance into his work as a neurologist.
When did you get interested in music?
Music—performance on the violin, particularly—has been a very big part of my life since I was 7 years old. It's what I seriously thought about doing professionally until high school, when I decided it would be an avocation.
I began to play in music school in the former Soviet Union before we immigrated to the US when I was 9. After a yearlong break of not being able to afford lessons, I'm happy to say I continued on scholarship in Philadelphia at the Settlement Music School. I played in the Philadelphia Youth Orchestra and the University of Pennsylvania Symphony, and I had a string quartet in college.
Fast-forward to my movement-disorder scholarship at Penn, where I was in the Hippocrates Trio, which consisted of me, a Penn dental student who was a cellist, and an MD/PhD student who was a pianist. As a trio, one highlight of our performance career was at the 2012 Penn Homecoming. We donned our white coats and played a movement from Mendelssohn's D-minor trio—and won second place in Penn's Band Slam. That was a wonderful moment for classical musicians everywhere because other participants were singers/songwriters, bluegrass bands, and rock bands.
“Looking back on it now, my takeaway is that, when it comes to music-based interventions, at least in plants, but perhaps also in animals and higher animals like people, one size will not fit all.”
—DR. ALEXANDER PANTELYAT
Music has been important for work/life balance and stress relief during both medical training and my career in medicine. It serves to center who I am, and I think it makes me a better physician and researcher.
How did you come to think of music as a therapeutic tool?
My fourth-grade project for the science fair in elementary school involved a music-related experiment, which my mom suggested and I implemented. We had three identical-looking plants that we put in the same windowsill to try to control for degree of sunlight. For one plant, there was silence; for another, there was the rock station on the radio; and the other heard the classical station. The results were that the plant that heard rock wilted, and the plant that heard the classical station grew at a faster rate over a four-week period, if I remember right, than the one exposed to silence.
That was the kernel of interest that has continued into my research. Frankly, I did not expect there would be a clear difference between the three plants and I certainly didn't expect the plant exposed to the rock station to wilt. I personally enjoy a lot of rock; I don't wilt with it, but the plant did. That made me wonder about how music influences things.
Looking back on it now, my takeaway is that, when it comes to music-based interventions, at least in plants, but perhaps also in animals and higher animals like people, one size will not fit all. The same kind of music may help one person and potentially hurt another. You need an individualized approach to music-based interventions in order to optimize benefit for specific people.
How does your interest in music influence your research today?
I started thinking seriously about the potential of rhythm-based interventions on diseases like Parkinson's disease during my fellowship. Our Parkinson's Disease Center at Penn put on an annual retreat for our patients, and a local West African drumming group called Odunde365 was invited to work with a group of our patients at the retreat. After a 45-minute group-drumming session, the patients were coming up to the organizers of the retreat, saying that various aspects of their symptoms had improved after just that one session.
So I convinced my fellowship director to provide some pilot funding for a study of West African drumming as an intervention for quality of life and mood and gait and balance measures in Parkinson's disease. We conducted that over a 12-week period with a control group of 10 patients pursuing their usual care and an intervention group who had the West African drumming twice a week for six weeks. We demonstrated a statistically significant improvement in quality of life in the intervention group. After six weeks of not drumming, the improvement on the quality of life questionnaire was lost—very much in line with studies of physical, occupational, and speech therapy in Parkinson's disease, currently the gold standard rehabilitative intervention. The control group did not improve on any parameters.
How did the Center for Music & Medicine get started?
When I was interviewing for my position at Hopkins, the chair of neurology, Dr. Justin McArthur, asked me to describe my ideal position or work situation. I thought to myself: “He's giving me the opportunity to ask. Nothing ventured, nothing gained.” So I told him I wanted to combine my interest in movement disorders and neurology with my interest in music and rhythm-based interventions. And he suggested that I ask around Hopkins to see if I could find some potential collaborators.
The serendipitous thing was the Peabody Institute at Hopkins, which is one of the pre-eminent music conservatories in the US, got a new dean who started in June 2014, and one of the first meetings I set was with him. It turns out that he came to the job with the thought in mind of developing a music therapy program.
Long story short, by January 2015, we had our inaugural meeting and now there are over 80 faculty members—from the School of Medicine, Hopkins' undergraduate campus and its schools, and the Peabody Institute—who are involved in some way.
What is the focus of the Center's work?
Our motto is: Music as medicine. Medicine for musicians. Music as medicine is what I focus on, but equally important for us is medicine for musicians. Arguably, that is just as groundbreaking because we are trying to create a new medical subspecialty, which is musicians' medicine. Currently there is a very small handful of experts around the world who can advise a professional musician who has been injured about what they need to do for rehab and treatment. And musicians only learn of them by word of mouth, so we need to make this field exist as a formal entity.
Is the Center working on anything that has implications for Parkinson's disease (PD) patients?
The first was our “Parkinsonics” study, which has developed into the ParkinSonics weekly singing group, and reflects what has come to be a model for us. We develop and carry out a clinical trial or clinical observational study of a music or rhythm-based intervention for Parkinson's disease or other neurodegenerative diseases such as Alzheimer's disease and, depending on the study findings and (crucially) the feedback from the study participants themselves, we work to develop a community-based group out of that study.
The results of Parkinsonics trial have not yet been published, but we saw some significant improvements. Even before the study was completed, many participants came to us to say, “I feel like I'm really gaining a number of things from attending this weekly choir, and I want to make sure that I get to continue after the study is over.” So we were able to arrange it by working with the Maryland Association for Parkinson Support, and our Parkinson's and Movement Disorders center at Hopkins is a co-sponsor. It has continued to meet weekly ever since 2016 and it has grown so it now includes patients with Parkinsonian disorders other than Parkinson's disease.
I recently paid a visit to the ParkinSonics singing group, and these people who didn't do any singing before—that was a requirement of our study design—are now singing four-part harmony. It is absolutely inspiring. They have 20 or more participants at every rehearsal and they have annual Christmas concerts that are well attended.
We also have a manuscript in preparation for our “Guitar-PD” study. My co-founder at the Center for Music & Medicine, Dr. Serap Bastepe-Gray, is a guitar ensemble teacher at Peabody who is also a trained occupational therapist and researcher. We are co-primary investigators on this study; we wanted to see if we could improve functionally important things like typing speed, which I think is a relevant measure nowadays, in patients with PD as a result of guitar lessons.
Similarly to the ParkinSonics study, before we even completed the study, participants came to us and said, “We would love to keep up with the guitar lessons because we feel we're benefitting on multiple fronts.” So the Peabody Preparatory program is now offering group lessons in guitar for patients with Parkinson's disease.
How do you see music as medicine evolving?
This is the most exciting time I can think of in terms of research into music and rhythm-based interventions for the brain, in part because of the incredible Sound Health partnership between the Kennedy Center and the National Institutes of Health, which started in 2017. Now $5 million has been earmarked by the NIH to be spread across 10 to 12 projects this fiscal year; this will move forward crucial research on the mechanisms of how music and rhythm impact the brain. I'm tremendously excited about these opportunities to come.
How do you find time for music at this stage of your career?
At this point, it's very much through the lens of being a new dad. I have a one-year-old son, and he's my first. I do a lot of Yankee Doodle variations, a lot of Old McDonald. So my repertoire in the last year has changed significantly, although he does really like Bach solo sonatas and partitas, so I do that for him. He starts waving his hands and kind of moving his entire body to the beat, which has been demonstrated, by the way, in some more formal studies of infants. Even in utero, but also 1-year-olds and 2-year-olds can react to music in very patterned ways.
I'm happy to say that there's a new string quartet that we've recently formed with students and faculty at Hopkins, so I will be getting back into playing some Beethoven now.