We present a report of a patient with refractory TLE due to hippocampal sclerosis with concomitant OCD on pharmacotherapy for both. She underwent surgery for standard anterior temporal lobectomy with amygdalohippocampectomy and reported improvement in obsessive—compulsive symptoms subsequently. We seek to further evidence of interaction between the two conditions and argue to undertake future research exploration on the same. The key features in OCD are recurrent intrusive ideas, impulses, or urges obsessions along with overt or covert behaviors compulsions aimed at reducing the distress. Epilepsy is frequently associated with wide-ranging neuropsychiatric manifestations,[ 3 ], incidence of which is much higher among the treatment-resistant epilepsy and TLE.
The highlight of this report is the remission of symptoms of OCD after anterior temporal lobectomy with amygdalohippocampectomy, which was primarily performed for achieving seizure freedom. In this manner, medial Temporal lobe dysfunction and ocd inputs would regulate hyperactivity of the orbitofrontal thalamic relays. Nuclear magnetic resonance study of obsessive-compulsive disorder. A comparative study of obsessive-compulsive disorder and other psychiatric comorbidities in patients with temporal lobe epilepsy and idiopathic generalized epilepsy. Vintage tubular brass trastorno obsesivo-compulsivo TOC. Br J Psychiatry. Functional magnetic resonance imaging of symptom provocation in obsessive-compulsive disorder. Quantitative analysis of interictal behavior in temporal lobe epilepsy. Mary M.
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Perhaps one of the reasons no one has come up with an answer Temporal lobe dysfunction and ocd autism is the way we have thought of it or rather did not think of it in medicine. One of the occd of OCD involving the perception of forced thoughts may occur from seizures themselves. Arch Neurol. Remission of an obsessive-compulsive disorder following a right temporal lobectomy. Large department stores with the movement, noise, bright lights are another trigger. The interictal behavior Temporal lobe dysfunction and ocd in temporal lobe epilepsy. Evidence supporting these theories is mainly speculative at this time, however. Parents noticed that something was "not dysfunnction in the Raunchy pix three to six months of life. These studies would have to use structured neuropsychological instruments, trained personnel, and a Free xx porn videos population to oocd eliminate biases inherent in many case series. Semantic dementia is one type of primary progressive aphasia.
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- Although it may be surprising to some, there is a longstanding association between epilepsy and various forms of mental illness.
- Obsessive-compulsive disorder OCD is a type of anxiety disorder in which a person repeatedly dwells on unwanted ideas or feels compelled to perform rituals to relieve tension.
Language: English Spanish French. Obsessive-compulsive disorder OCD has long been associated with epilepsy. The link with temporal lobe usually refractory epilepsy TLE is particularly prominent. Data on the links include case reports, case series, and controlled studies.
TLE foci may be either left- or right-sided. The neurobiology implicates a pathophysiological or structural impairment of the orbitofrontal-thalamic, and frontothalamic-pallidal-striatal-anterior cingulate-frontal circuits. Discrete anatomic lesions in these pathways, or their surgical removal, may induce or conversely improve OCD in TLE patients. El trastorno obsesivo-compulsivo TOC.
Los focos de la ELT pueden estar al lado izquierdo o derecho. Obsessive-compulsive disorder OCD includes a range of clinical characteristics with two major components. There is firstly the intrusion of thoughts, ideas, or compulsions; and secondly, the resulting triggering of abnormal behaviors or rituals. These actions may serve to resolve the mental imperative of the intrusive thoughts by inducing the person to perform repeated actions or movements that often appear ritualistic.
The ritual is composed of sets or sequences of these behaviors, often in order, and may consume much of the patient's waking attention. However, despite a number of case reports, no unifying theory of causation has been clearly established. An increased prevalence of OCS, however, has been noted in refractory epilepsy, 3 particularly with temporal lobe epilepsy TLE.
There is therefore interest in whether these two conditions are causally linked. There may be many possible causes. Patients with epilepsy may also express a number of patterns of behavioral abnormality and personality characteristics, and experience memory, emotional, behavioral, and social disabilities.
This review will examine the links between OCD and epilepsy, and review the evolution of the literature on case reports, case series, and larger retrospective controlled studies. Included will be the components of OCD seen in epilepsy, effects of medical and surgical treatments, and an overview of the theoretical neurobiological underpinnings that might link the two disorders.
Teasing out the elements, types, and causes of behavioral disturbance in epilepsy presents a challenge. It is not clear whether the behavioral changes that occur following seizures or with epilepsy may, for example: i arise from the epilepsy itself; ii may appear as a form of forced change induced by the seizure; iii might arise from reactive or released behaviors after the seizure as a postictal phenomenon ; or iv may be a comorbid psychiatric condition which often occur in epilepsy.
Quite aside from the acute effects of acute seizures, is the possibility that it is the chronic progression of the epileptic disorder that might predispose to the appearance of OCS among the many possible psychiatric consequences of epilepsy. These mechanisms might also apply to the many different types of seizures that exist in the family of epilepsy syndromes, along with the various underlying and differing cerebral insults both etiological and anatomical that can cause epilepsy.
In looking at possible seizure types that are associated with OCD, it seems that exclusively generalized tonic-clonic seizures are rarely associated with OCS. There has been a long-standing observation that patients with various types of epilepsy had a higher incidence of many psychiatric conditions. Some examples published as case reports delineate this relationship. Bear and Fedio suggested that the 2.
Individual case reports or small series have led to the suggestion that a right hemisphere proclivity exists for manifestation of OCD in patients with TLE.
There have also been other reports of lateralized abnormalities when TLE patients with OCD had magnetic resonance imaging MRI studies which revealed structural abnormalities, or had electroencephalographic EEG asymmetries.
Although a number of studies with a small number of subjects indicated a link between TLE and OCD, there were few group studies.
It awaited the development of better retrospective and prospective studies to explore the similarity noted between the forced thinking seen in some patients with TLE and OCD, and to determine whether there was merely a chance comorbidity, or a clear association. These studies would have to use structured neuropsychological instruments, trained personnel, and a control population to help eliminate biases inherent in many case series.
They found that patients with OCD manifested abnormalities on neuropsychological tests that involved nonverbal memory and visuospatial tasks. Hence, in TLE, compulsions may be particularly favored. Isaacs and colleagues suggest that doubting, checking, and hoarding in particular might represent the effects of behavioral impairments in patients with TLE, for example related to a problem in memory; while hoarding might reflect deficits in organization stemming from frontal lobe problems.
The work by Monaco and colleagues has also been influential in exploring these links. They evaluated obsessionality as a trait using a Minnesota Multiphasic Personality Inventory 2 MMPI-2 version addressing the Pt clinical scale and OBS content scales that contain evaluations of characteristics of compulsions, excessive doubts, obsessions, perfectionist personality traits, and fear.
The particular OC features investigated included neutralizing, checking, doubting, ordering, hoarding, and washing. This indicated that obsessionality is a TLE trait in patients with a biological predisposition, with a prior psychiatric history.
In turn, this would suggest that there is a link between mesolimbic regions and particular personality characteristics, a link previously believed to exist in TLE patients. The study further supports the concept that involvement of particular brain areas, by the various epilepsy syndromes will be relevant to the appearance of specific psychopathological expression and psychiatric conditions.
An unsettling finding in the Monaco study is that only one of the nine patients had been previously diagnosed with OCD, indicating that OCD is poorly recognized in an outpatient epilepsy patient population. One reason may well be the relative lack of investigators trained in psychiatry in an outpatient epilepsy clinic setting. Regarding mechanisms, the authors note that the amygdala is involved in OCD, and has major connections with the striatum.
Such affective and motivational components facilitate the conduction of automated often ritualistic behavior in response to danger. The reciprocal links to the amygdala, ventral striatum, and stria terminalis may serve the anxiety-modulating effects of rituals and repetitive behaviors. Ertekin and colleagues built on the prior investigations and constructed a study to evaluate the associations of TLE arising from unilateral mesial temporal sclerosis MTS , and IGE with psychiatric comorbidities including OCD 10 They compared 29 TLE patients with 27 IGE patients from an epilepsy clinic population, and with 30 control subjects, they employed investigators experienced in epilepsy and psychiatry.
The commonest comorbidity with OCD was depression, 10 and there was a left-sided predominance in this association with TLE. Overall, psychiatric comorbidity in the epilepsy population probably arises from many sources. Principal among them probably is a combination of social and neurobiological interplay.
Lending support to the effect of the chronicity of an enduring condition, is the study by Swinkels and colleagues who noted that both predisposition and brain dysfunction played a part. Some patients with TLE have greater preoccupation with existential aspects of religion.
Frontal lobe epilepsy FLE is another likely candidate as a fellow traveler with OCD, possibly because of the executive and behavioral functions subserved by this part of the brain. From a neurobiological perspective, dysfunction in this region affects part of the frontal-cingulate-thalamic-limbic circuit, and hence might favor the functional dysregulation of this circuit, thus inducing elements of OCD.
Another candidate is limbic epilepsy, with its unusual automatisms which may simulate the ritualistic behavior of OCS. Patients may display repetitive movements and types of automatic behavior. Other rarer conditions may possess both epilepsy and rituals or at least repetitive behaviors as clinical expressions of a particular disease.
Examples include the handwringing seen with Rett Syndrome, and other behavioral features noted with Angelman syndrome and autism spectrum disorder. There has been an increasing effort to formulate a neurobiological underpinning to OCD. Various theories have been advanced, and have been supported by the findings of OCD triggered by a number of neurological conditions.
These include head trauma, brain tumors, cerebral infarction, and seizures. Modell and colleagues suggest that there are two principal loops or circuits underlying control of the behaviors involved in OCD. The latter loop controls the activity in the thalamo-orbitofrontal circuit. Normally, orbitofrontal cortex activates the caudate and then the pallidum so as to inhibit the medial thalamic nucleus that then feeds into the frontal cortex.
In this manner, medial thalamic inputs would regulate hyperactivity of the orbitofrontal thalamic relays. Dysfunction of these circuits might produce OCD, with increased activity inducing obsessive characteristics and compulsive traits. However, complicating this paradigm is the paradoxical clinical resolution in some cases of established OCD by the new appearance of one of strokes, tumors, or by deep brain stimulation. Abnormally functioning circuits include the thalamus, basal ganglia, anterior cingulate gyrus, and the orbito-frontal cortex.
These circuits pass through the frontal-thalamic-pallidal-striatal areas and back to the frontal regions, transiting via the anterior cingulate gyrus and the internal capsule. To support the concept of this specific circuitry underlying OCD is the finding that disruption of this pathway by surgical anterior internal capsulotomy and anterior cingulotomy enables improvements in OCD.
Patients with OCD from neurological disease had less anxiety with the compulsion than did those with the idiopathic form.
Huey and colleagues postulated that the anxiety and impulse towards particular behaviors are requited only when the behavior is completed. Theories underlying the particular association between OCD and epilepsy include not only a possible shared mechanism, but an incidental OCD problem in patients with epilepsy.
One of the components of OCD involving the perception of forced thoughts may occur from seizures themselves. In the classification of seizures, those seizures that involve part of the brain and which do not impair vigilance or memory, are termed simple partial seizures. It has long been noted that obsessive thoughts can occur in the preictal period, be caused by simple partial seizures as an ictal phenomenon, or occur in the postictal period. Some speculate that this might occur in the limbic circuit, and induce OCD problems.
However, there is little evidence for this theory. Problems with this theory are the absence of a single focus of neuronal deficit in OCD. Because of the finding of depressive comorbidity with OCD in epilepsy, limbic dysfunction might represent an underlying neurobiological underpinning.
Clinically, patients with OCD should therefore be assessed and treated for depression. In contrast to the appearance or the worsening of OCD with temporal lobe surgery as mentioned above, a subgroup of patients with particularly temporal-lobe foci may significantly benefit from resective surgery. Many types of underlying premorbid psychopathology may get worse following epilepsy surgery, even when epilepsy improves. Such tendencies can be evaluated before surgery and may well factor in the decision whether to advocate this treatment in affected patients.
Other neurosurgical studies support the involvement of neural loops in OCD in patients with epilepsy, and the subsequent improvement that can occur following surgery 54 To reinforce the involvement of frontal pathways, Kulaksizoglu and colleagues review the reports on the dysfunction of frontal subcortical circuits, and the abnormalities in visual-spatial and nonverbal tasks that particularly implicate right subcortical frontal circuits in the process.
There is much work to be done in establishing the causation of OCD, and possible links to epilepsy. Future studies should extend investigation to nonepilepsy neurological groups as well as a psychiatry group with OCD.
In addition, with the findings of greater religiosity and writing compulsions in patients with epilepsy, research into OCD in epilepsy would be enhanced by developing specific tools or scales that measure these parameters. As with any implied association, prospective larger studies with optimally trained personnel with experience in psychiatric testing instruments, the development of tailored characterization of OCD subtypes and feature categorization, and the application of these tools and trained personnel to carefully categorized populations of different types of epilepsy, are warranted.
Multicenter trials would have a good chance of lending support to the neurobiology, causes, and optimal management in patients with the several types of epilepsies and varieties of OCD. National Center for Biotechnology Information , U. Journal List Dialogues Clin Neurosci v. Dialogues Clin Neurosci. Peter W. Author information Copyright and License information Disclaimer. E-mail: ude.
This article has been cited by other articles in PMC. Abstract Obsessive-compulsive disorder OCD has long been associated with epilepsy.
Hugs, Bambi. Mental state and temporal lobe epilepsy. They are quiet sometimes and hyper at other times. Neuroimaging and frontalsubcortical circuitry in obsessive-compulsive disorder. Some investigators have tried to use the connection of OCD with epilepsy to look for information about the mechanisms underlying each disorder. Epilepsy and Developmental Disabilities.
Temporal lobe dysfunction and ocd. Publicación oficial de la Asociación Latinoamericana de Sociedades de Biología y Medicina Nuclear
We present a report of a patient with refractory TLE due to hippocampal sclerosis with concomitant OCD on pharmacotherapy for both.
She underwent surgery for standard anterior temporal lobectomy with amygdalohippocampectomy and reported improvement in obsessive—compulsive symptoms subsequently. We seek to further evidence of interaction between the two conditions and argue to undertake future research exploration on the same.
The key features in OCD are recurrent intrusive ideas, impulses, or urges obsessions along with overt or covert behaviors compulsions aimed at reducing the distress. Epilepsy is frequently associated with wide-ranging neuropsychiatric manifestations,[ 3 ], incidence of which is much higher among the treatment-resistant epilepsy and TLE. We describe a patient with drug-resistant TLE due to hippocampal sclerosis with OCD who had improvement of her neuropsychiatric symptoms of OCD following surgery for temporal epilepsy.
A year-old right-handed female, with normal development, had presented with recurrent episodes of seizures since 11 years of age. The semiology was in the form of an aura of fearfulness followed by behavioral arrest, bimanual automatisms with hypersalivation, and subsequently, left upper-limb posturing with rare secondary generalization, suggestive of right medial temporal involvement.
She also had aggressive, harmful obsessions with magical thinking and cognitive compulsions. Her primary obsession was excreta sticking to body parts after passing stools. These symptoms were suggestive of OCD. The patient underwent evaluation for drug-resistant focal epilepsy. Magnetic resonance imaging MRI brain [ Figure 1 ] was suggestive of right mesial temporal sclerosis MTS , and video-telemetric electroencephalogram EEG [ Figure 2 ] showed right anterior and middle temporal onset of seizures.
Positron emission tomography PET -computed tomography revealed moderate-to-severe hypometabolism of the right temporal region. Neuropsychological evaluation showed right temporal involvement. In view of drug resistance and clinico-electro-radiological and neuropsychological concordance, she underwent right anterior temporal lobectomy with amygdalohippocampectomy. There was no immediate postoperative complication.
T-2 weighted MRI showing right hippocampal volume loss and a mild dilation of the right temporal horn. After 10 months of surgery, levetiracetam was tapered and topiramate was introduced. The repeat neuropsychological evaluation at 6-month post-operation showed dorsolateral prefrontal and temporal lobe involvement. She reported that her subjective quality of life had significantly improved due to decrease of OCD symptoms.
The highlight of this report is the remission of symptoms of OCD after anterior temporal lobectomy with amygdalohippocampectomy, which was primarily performed for achieving seizure freedom. TLE has been associated with obsessive—compulsive syndrome quite prominently, especially refractory epilepsy of the temporal lobe. Till date, several researchers have proposed the involvement of the temporal lobe in obsessive—compulsive syndrome, with EEG abnormalities being reported over the temporal lobe.
A few case reports also suggest a similar dynamic relationship between the temporal lobe and OCD where remission of OCD symptoms was seen after temporal lobectomy. Guarnieri et al. Similarly, remission of OCD symptoms after temporal lobectomy was first reported by Kanner et al. Classical models of OCD suggest involvement of two principal cortical loops. These are the thalamo-orbitofrontal loop mediated by glutamate and a collateral loop that includes striatal-thalamic-cortical STC interconnections mediated additionally by serotonin, dopamine, and gamma-aminobutyric acid GABA.
The STC circuits involve mainly the frontal cortex. The communication fibers from the frontal cortex travel to the basal ganglia through the internal capsule and the anterior cingulate. Disruption of this pathway has been implicated in the organization of OCD symptoms.
This is supported by the evidence of improvement in OCD symptoms followed by capsulotomy and anterior cingulate resection. Evidence shows increased default mode network deactivation in resting-state studies in TLE patients with affective disorders, particularly in the subgenual anterior cingulate cortex.
The occurrence of OCD in patients with TLE and its remission rarely with temporal lobectomy have both been well documented.
With the severity of OCD increasing with greater duration of uncontrolled seizures, such an undertaking will not only be important for prognostication but also for improving the quality of life for the patients concerned. It will also provide opportunity to understand the biological basis of OCD. National Center for Biotechnology Information , U. Ann Indian Acad Neurol. Shreedhara , 1 G. Bhargava , 1, 2 Raghavendra Kenchaiah , 1 C. Janardhana Reddy , 6 and Sanjib Sinha 1.
Janardhana Reddy. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: ni. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4. Keywords: Anterior temporal lobectomy and amygdalohippocampectomy, obsessive-compulsive disorder, temporal lobe epilepsy, mesial temporal sclerosis.
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