X-System: Improving the Well-Being of Children With Epilepsy

In 2024, we launched a new initiative to reduce epileptic brain activity and improve the well-being of children living with epilepsy. This initiative leverages technology developed by X-System, which utilizes music as a non-pharmacological and enjoyable treatment modality for neurological conditions.

Epilepsy is a chronic neurological disorder characterized by abnormal electrical activity in the brain. Its primary biological marker is abnormal cerebral rhythms detected via electroencephalogram (EEG). The onset of this condition triggers epileptic seizures, which can manifest in various ways, from momentary loss of consciousness to severe convulsions and complete loss of motor control. Epilepsy can develop at any age, with the frequency and intensity of seizures varying significantly from one patient to another.

Epilepsy is one of the most common neurological diseases on the planet.

What are the treatment options for epilepsy?

Today, physicians identify around 40 types of this disorder, the most severe of which entail sudden seizures, convulsions, and loss of consciousness. The unpredictability of these seizures, the constant anticipation of them, and the fear of societal rejection are factors that exacerbate the suffering of patients grappling with this condition.

In 60-70% of cases, children with epilepsy can be helped with medication. The remaining children with epilepsy are resistant to pharmacological treatment. In Ukraine, approximately 100,000 patients suffer from epilepsy, with every fourth being a child. The lives of these children are under constant scrutiny; even the slightest trauma or stress can trigger severe seizures. Due to the war, the condition of most children worsens: stress, sounds of sirens and explosions, unpredictable movements, and limited access to medication in some regions negatively impact the brain and its electrical activity.

Over the past thirty years, around two dozen antiepileptic drugs have been proposed for treating 30-40% of patients with persistent seizures. Those introduced since the year 2000 are considered the “third generation.” Their development was preceded by various innovative methods of modifying the biochemistry of existing compounds or introducing new agents. However, evaluating their effectiveness remains an open question. Some scientists argue that long-term cohort studies have shown that second-generation drugs do not improve the overall prognosis of epilepsy. There appears to be no evidence to support any second-generation or third-generation antiseizure medications to be as efficacious as valproate monotherapy for generalized and unclassified epilepsies.

Pharmacoresistant epilepsy is defined by the International League Against Epilepsy (ILAE) as a condition where an individual fails to achieve seizure control after adequate trials of two antiseizure medications. There have been attempts to utilize non-pharmacological methods to alleviate seizures. Among these, the most invasive include resective neurosurgical interventions or surface stimulation using Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (anodal or cathodal), both of which are still in the trial stage. Epicranial cortical stimulation with the EASEE system is an option, albeit requiring a subcutaneous implanted pulse generator. Peripheral nerve stimulation through Vagus Nerve Stimulation (VNS), transcutaneous stimulation of the trigeminal nerve, and focused ultrasound are also viable options. These approaches necessitate patient hospitalization for the surgical implantation of the pulse generator, with precise lead placement to the vagus nerve being crucial in VNS cases. Complications such as wound infections, rare unilateral vocal cord paralysis and hoarseness, as well as instances of dysphoria or psychosis, may arise and pose challenges.

Recently, the potential use of neurostimulation for epilepsy has offered new insights and approaches. The neurophysiological changes provided by music are linked to important subcortical, cortical, basal ganglia and limbic structures, which potentially allow music to entrain our brains, in other words, to adapt (synchronise) to the external rhythms and harmonies of music.

The implementation of musical therapy methods for children with epilepsy and the institutionalization of music therapy in Ukraine may open up new perspectives for improving the quality of life of children facing this condition.

How does the X-System operate?

X-System is a cutting-edge technology that enables the mathematical modeling of human brain reactions to sound. It was developed based on the research and practical expertise of British professors Paul Robertson and Nigel Osborne, who have dedicated many years to enhancing people’s well-being through the use of music. Their findings on human responses to musical patterns serve as the basis for the X-System.

The authors of this technology have developed and are currently actively enhancing an application that utilizes selected music as a treatment method for intractable epilepsy, which is challenging to control and alleviate. The uniqueness of this method lies in its entirely non-pharmacological approach and its reliance on the healthiest phases of children’s brain activity during deep sleep. Preliminary trials of the X-System showed a 22.5% reduction in interictal epileptiform discharges, a 4.2 percentage point increase in REM sleep, and a 0.68-point decrease in seizure severity on the ELDQOL scale. The trials also recorded substantial improvements in quality of life, deep sleep, and REM sleep, with no adverse reactions reported.

The X-System is classified as a Class I medical device according to MHRA (UK) standards and EU MDR (awaiting confirmation). It is registered and approved as medical software by the International Organization for Standardization (ISO). Currently, the device is undergoing extended trials at Srebrnjak Children’s Hospital in Zagreb, Croatia.

Declaration of conformity

Project Results

The project ran from April 2024 to July 2025 at the St. Nicholas City Children’s Hospital in Lviv, which was selected through an open call.

Treatment using the X-System technology was provided to 20 children aged 4 to 17 from various cities across Ukraine. The participants had different forms of epilepsy and comorbid conditions. For each child, an individually tailored playlist was created and listened to according to a specially defined schedule.

The effectiveness of the therapy was evaluated based on:

EEG results before and after therapy;
doctors’ observations;
feedback from the children and their parents;
quality-of-life questionnaires prepared by a psychologist.

In some children, a reduction in epileptiform activity and the number of psychogenic seizures was recorded, and seizures became less pronounced. In others, EEG changes were minor or absent. In several cases, the effect was observed only during the first few months, after which it faded.

At the same time, most children showed positive psycho-emotional and behavioral changes:

improved sleep (the most common effect);
reduced aggression and irritability;
improved concentration and memory;
positive changes in social interaction (children became calmer and more engaged).

One mother shares her impressions of the music therapy: “She really enjoys it. She says she dreams of beautiful things. I’ve noticed she wakes up calmer, without the usual morning groans of ‘I don’t want to,’ ‘I can’t,’ or ‘I won’t.’ I haven’t seen improvements in her schoolwork yet, but I’m hopeful that will come.”

“This girl had a very severe form of epilepsy: each seizure led to a critical status requiring emergency intervention. After including her in the study program, we managed to control her seizures, although many challenges remain, so each positive change is a great joy,” comments pediatric neurologist and epileptologist Olga Tychkivska.

“A myriad of positive effects were observed in the children that underwent X-System’s personalised music as a treatment for epilepsy. In general terms, the treatment induced a mild to moderate improvement in quality of life in the vast majority of patients, while a minority of patients saw huge and potentially life changing improvements to their epilepsy due to the treatment. No patients that underwent the treatment were worse off after treatment. In terms of physical changes to the epilepsy, around a third of the treated patients saw major improvements metrics like inter-ictal discharges, seizure severity, and seizure frequency. In the case of one patient, the signature of epilepsy in EEG (spikes), disappeared completely after treatment. Another specific patient saw improvements in their hyper-kinetic movement disorder, which was the first time such an improvement was observed due to the
treatment.

In addition to these physical changes, an attempt was made to measure the general quality of life of patients before and after treatment using questionnaires (QOLIE-31 and ELDQOL) and diaries that parents kept during treatment. Around 80% of patients saw an improvement in their quality of life due to the treatment. Specific aspects of life that improved include; quality of sleep, memory, hyperactivity, aggression, mood, tantrums, concentration and emotional processing,” comments on the results X-System specialist Ruaraidh Osborne.

Conclusions

Music therapy using X-System can be an effective complementary non-pharmacological method in the comprehensive treatment of epilepsy. The most notable effects are seen in improved sleep, reduced hyperactivity, increased concentration, and emotional stabilization. Given these results, X-System also shows potential for use in treating insomnia, anxiety, post-traumatic stress disorder, and chronic depression.

Education Program

As we began the project, we encountered a shortage of technical staff qualified to conduct EEGs. Unlike in European practice, EEGs in Ukrainian hospitals are typically performed by physicians, who already have limited time for such tasks.

Therefore, in collaboration with our project partners — the Unbroken Rehabilitation Center and the X-System team — we launched an educational program for young doctors and interns to learn EEG techniques in Zagreb, Croatia.

As of August 2025, two doctors from Lviv’s First Medical Association completed a week of training at Srebrnjak Children’s Hospital. Following this, one will apply her skills working with children with epilepsy at St. Nicholas Children’s Hospital, while the other will work with veterans and military personnel at the Unbroken Hospital.

We are deeply grateful to the main pediatric neurologist Romana Gjergja Juraski and neuropediatrician Melita Cacic Hribljan of Srebrnjak Children’s Hospital for their valuable lectures on polysomnography, as well as to trainers Ivana Marušić and her colleague Hrvoje for the practical sessions provided to our doctors.

Unfortunately, a short training period without extensive hands-on experience with EEG equipment is not sufficient. “They have “good hands”, good attitude and real potential… They just need EEG/PSG machine and patients to practice and develop their skills,” says Ivana.

We will continue working to expand training opportunities and increase the number of doctors sent for internships in Zagreb. We hope this initiative will spark discussions on the need to create a technical specialist role for EEG procedures within Ukraine’s professional classifications and to incorporate this position into the staffing plans of neurological departments in Ukrainian hospitals.

The project was implemented with the financial support of the Terre des Hommes Deutschland and donations from benefactors via the GlobalGiving platform.