Music reshapes basal ganglia neural state dynamics toward a medication-like regime in Parkinsons disease

Parkinson disease (PD) is characterized by excessive neural synchronization in the 13 to 30 Hz beta band within basal ganglia circuits. Conventional therapies, including dopaminergic medication and deep brain stimulation (DBS), reduce beta synchrony while enhancing lower-frequency theta activity. As an adjunct to these treatments, music and auditory rhythms improve motor function in PD, but the neural mechanisms remain unclear. Here, we recorded local field potentials in the subthalamic nucleus (STN) of patients with PD in the medication off state to test how structured musical elements shape subcortical synchrony. Spectral and neural state-space analyses showed that rhythmic and harmonic components of music produced effects comparable to dopaminergic therapy, suppressing beta-band oscillations while enhancing theta band activity. These effects were strong in the dorsal sensorimotor STN, whereas the ventral limbic STN showed minor modulation. Directional connectivity analysis further revealed that music-induced beta and theta changes were accompanied by increased cortex to STN drive, consistent with top down recruitment of the cortical subthalamic hyperdirect pathway. Notably, harmonic consonance produced network-level modulation comparable to, and in some cases greater than, rhythmic entrainment, extending beyond the established framework of beat based basal ganglia engagement. Together, these findings identify frequency selective, region specific, and stimulus-locked mechanisms by which music reshapes pathological basal ganglia activity in PD, providing direct electrophysiological evidence that auditory stimulation can transiently shift subcortical dynamics toward a medication like state.