Letter to the editor
imagery4.
‘Developmental dysmusia (developmental musical dyslexia)’
SIR–The term amusia, denoting an impaired capacity for
musical activity, was introduced by Knoblauch in 18881.
This letter will be mainly concerned with an aspect of this
which appears to be a definite entity; an inability to read
a musical score. This may be acquired as a result of cere-
bral lesions, but there is some evidence that it can occur as
a developmental disorder. Language function, and that of
music, have many similarities, displaying receptive and
expressive features, as well as those of composition or
invention, and comprehension; although there are obvi-
ous differences2. Although the skills of learning to read
words and music do overlap, they appear to involve differ-
ent areas of the brain.
Reports of developmental musical dyslexia are rare.
This is not surprising, considering that relatively few chil-
dren learn to play a musical instrument, and if they find it
difficult, are likely to abandon the task. However, a child
who is eager to learn may feel very frustrated to find it so
problematic, and unhappiness and loss of self-confidence
may ensue. If a specific disorder can be identified, then the
child can be reassured that their difficulties are not due to
lack of effort or to stupidity.
An inability to read a musical score can certainly be
acquired as a result of a cerebral lesion, such as a throm-
bosis or haemorrhage. There have been several reports of
an acquired inability to read music among trained musi-
cians, and of musical alexia among adults in association
with receptive aphasia, and with receptive and expressive
amusia; although not of isolated defects in the reading of
music without other linguistic or musical disabilities3. If
an acquired disability of this kind can occur there seems
to be no reason why a developmental musical dyslexia
should not occur; taking the analogy of acquired and
developmental dyslexia. It is known that there are a num-
ber of competent professionals engaged in popular music
who cannot read musical notations, so why not young
musical students?
The faculty of score reading is variably developed, and
while there are many musical people who can read a
known work or one which is unknown but not too com-
plex, there will be few who can successfully read an
unknown complex composition. While it is possible to
comprehend the meaning and imagery of a piece of
prose, and more arguably verse, by the simple act of
reading to oneself, reading music is an incomplete expe-
rience unless the music is heard within the reader’s per-
ceptual world. This demands the addition of
instrumental timbre, the quality of the sound produced
by a particular instrument depending on the number
and character of the overtones. However, timbre is weak-
ly represented in musical notation. The score only
becomes fully alive when heard in the mind of the artist
before it is played or when translated by performance
into music. Nevertheless, it is apparent that the language
of music is conveyed by reading to those who are appro-
priately educated, and more fully to individuals who
214 Developmental Medicine & Child Neurology 2000, 42: 214–215
possess considerable powers of auditory memory and
The basic unit of language is the phoneme, of which
there are 42 in English, while in music it is the single note or
chord. It may be that the left hemisphere is dominant for
language and the right hemisphere for music in most peo-
ple, or more likely there is bilateral representation for the
reception of the latter with hemisphere specialisation5. This
is strongly supported by the studies of Sergent et al.6. Using
positron emission tomography and magnetic resonance
imaging, individuals reading a musical score without lis-
tening or playing, showed bilateral activation of the
extrastriate visual area. The left lingual and fusiform gyri,
normally engaged in the visual processing of words were
not activated by the musical notations but the left occipito-
parietal area was recruited. In contrast to reading words,
the relevant information contained in musical notations is
derived not through feature analysis of the notes but
through analysis of their spatial location. These results are
compatible with cerebral connections underlying musical
functions being separate but adjacent to those subserving
language functions.
Henson2 cites a personal example of a child who had dif-
ficulty in reading a musical score. This was a boy whose
disability was not discovered until the age of 10 years by
which time he was playing the piano exceptionally well, as
he had been learning his pieces ‘by ear’. Many years later
he still finds it easier to learn a work by listening to the
music rather than by reading it, which he still finds diffi-
cult; just as certain aspects of dyslexia can persist into
adult life. I am aware of a similar example: a girl, aged 12
years, has been learning to play the piano for about 4 years
and is making good progress but still has difficulty in read-
ing a musical score, claiming that when looking at the
score the notes seem to be a lot of meaningless dots with no
real pattern to them. She learns to play the music by hear-
ing and subsequently memorising the notes, and by being
told where they are on the keyboard. She is a poor speller
and a slow reader, but does not seem to have significant
difficulties in those areas.
The evidence supports the presence of two spheres of
activity underlying language and musical functions,
which are mediated by distinctive neurobiological sys-
tems, in spite of qualitative and quantitative associations
between them. This is confirmed by the evidence from loss
of function and it may be equally true when it comes to
the acquisition of a skill. As with other specific learning
disabilities, there may be a number of reasons for such
problems, from poor teaching to inadequate vision.
However, if a specific learning disorder can be estab-
lished, apart from reassuring the child, learning musical
pieces ‘by ear’ can be stressed. However, the purpose of
this letter is a hope that others may be able to report simi-
lar examples, and suggest other ways in which such chil-
dren can be helped.
Neil Gordon MD FRCP
Huntlywood
3 Styal Road
Wilmslow
SK9 4AE, UK
E-mail: neil-gordon@talk21.com
References
1. Knoblauch A. (1888) Über Störungen der musikalischen
Leistungfähigkeit infolge von Gehirnläsionen. Dt. Arch. Klin.
Notices
Med. 43: 331–52.
2. Henson RA. (1997) Neurological aspects of musical experience.
In: Critchley M, Henson RA, editors. Music and the Brain.
London: William Heinemann Medical Books.
3. Benton AL. (1997) The amusias. In: Critchley M, Henson RA,
7th World Congress of the World Association for Infant
editors. Music and the Brain. London: William Heinemann Mental Health (WAIMH)
Medical Books. Montréal, Québec, Canada. July 26–30, 2000
4. Henson RA. (1997) The language of music. In: Critchley M,
Henson RA, editors. Music and the Brain. London: William The topic of the congress is Diversity: Challenges and
Heinemann Medical Books.
5. Wertheim N. (1997) Is there an anatomical localisation for Opportunities in Infancy. The theme will be discussed
musical faculties? In: Critchley M, Henson RA, editors. Music and within the context of brain behaviour, developmental
the Brain. London: William Heinemann Medical Books. psychopathology, culture, environmental health, caregiv-
6. Zuck E, Terriah S, MacDonald B. (1992) Distributed neural ing and special babies/special caregivers. This congress is
network. Sergent underlying musical sight-reading and keyboard
performance. Science 257: 106–9.
relevant to all individuals working with preschool children
and their families. For further information please contact:
WAIMH/Secretariat, 550 Sherbrooke Street West, West
Tower, Suite 490, Montréal, Québec, Canada H3A 1B9.
Tel: +514 398 3770; Fax +514 398 4854.
E-mail: waimh@ums1.lan.mcgill.ca
Website: http://www.mcgill.ca/mco.waimh

UK Epilepsy Drug Trial – Invitation to Participate

The Place of New Drugs in the Treatment of Epilepsy

The past decade has seen the licensing of five new

antiepileptic drugs in the United Kingdom, and more are
likely to follow in the near future. Unfortunately, the clini-
cal trials required to obtain a licence for a new drug do not
answer important practical questions about how and
when we should use them. In particular, studies that com-
pare new versus the standard drugs are largely lacking.
Because of this, the NHS Research and Development
Health Technology Assessment Programme is sponsoring a
pragmatic study which will compare carbamazepine and
valproate as standard antiepileptic drugs with recently
licensed competitors, gabapentin, lamotrigine, and topi-
ramate. It will compare monotherapy with these drugs
across a range of clinical, psychosocial, and health eco-
nomic outcomes, with the aim to recruit 3000 patients in
the United Kingdom within the next 3 years. Because
epilepsy has its highest incidence in childhood and adoles-
cence, it is very important that these groups are represent-
ed in the study.
Many of you may have already received information on
this study. If you have not and would like to do so, please
contact: SANAD Study Office, University Department of
Neurological Science, The Walton Centre for Neurology and
Neurosurgery, Lower Lane, Liverpool L9 7LJ.
Tel: 0151 529 5464, Fax: 0151 529 5466.
E-mail: bessan-p@wcnn.co.uk

Letters 215