A comparative study on obsessive compulsive symptoms in temporal lobe and generalized epilepsies

Background& Objective: Temporal lobe epilepsy has been associatedwith psychopathology especially obsessive-compulsive (OC) traits or symptoms as one of it’s specific personality characteristics as compared to other epilepsies. This study was undertaken to assess the prevalence and type of OC symptoms in patients with complex partial seizures (CPS) and generalized seizure disorders and the association of OC symptoms with right or left sided lesions in patients with CPS. Methods: Thirty patients each of CPS and generalized seizure disorder were enrolled to study OC symptoms with the help of the Padua Inventory, a 39 item measure of obsessions and compulsions on 5 content areas relevant to obsessive compulsive disorder. A proforma was prepared to study the various demographic variables, details of seizure disorder and MRI findings. Results: Ninety three per cent of CPS patients had OC symptoms as compared to 40% generalized seizure patients which was statistically significant. Dressing and grooming compulsions, contamination obsessions and washing compulsions were predominant in both the groups. On all the domains of the Padua Inventory, the CPS patients had statistically significant dysfunction than the generalized seizure patients. A highly significant association between left sided temporal lobe sclerosis for obsessions of contamination and washing as well as dressing and grooming was seen in the CPS patients. Conclusions: Involvement of different brain structures in different epileptic syndromes, plays a role in the susceptibility to develop specific psychopathological disorders like OC symptoms or obsessive compulsive disorder which are seen more in CPS as compared to generalized seizures. Neurology Asia 2016; 21(4) : 333 – 339 Address correspondence to: Professor Neena S Sawant, Department of Psychiatry, Seth GSMC & KEM Hospital, Acharya Dhonde Marg, Parel, Mumbai400012, India. Tel (O): 022 24107492, Email: drneenas@yahoo.com INTRODUCTION Behavioral and emotional changes in patients with epilepsy are very common. Epilepsy especially temporal lobe epilepsy (TLE) has been associated with psychopathology ranging from mood disorders, anxiety disorders, psychosis and specific personality characteristics. A link between epilepsy and the development of specific personality characteristics in patients with TLE has been studied by several researchers. In TLE, obsessive compulsive (OC) symptoms may be present as a discrete disorder or as a part of some other psychiatric syndrome. Though the aetiology of OC symptoms in epilepsies still remains unclear, there seems to be evidence of pathological dysfunction in the limbic system, basal ganglia and orbito-frontal region. Several studies report on OC traits or symptoms as one of the personality characteristics of TLE and involvement of the limbic system is considered to have a pathogenic basis common to both TLE and obsessive-compulsive disorder (OCD). Despite the heterogeneity of OC symptoms, researchers have found at least some evidence that specific neurobiological dysfunctions mediate the disorder. A number of studies published in the 1980s and 1990s reported a more specific association between OCD and epilepsy. Most of the evidence linking OCD with epilepsy has come from case studies and clinical observations, rather than from studies of large groups or comparison in different types of epilepsies. The prevalence of OCD is found to be in the range of 14% to 22% in various studies. However the prevalence of OC symptoms and traits has not been studied extensively. Some researchers have also found that lateralization of seizures is associated with different psychopathology whereas some did not find any evidence to support the notion. This study was therefore designed to assess the Neurology Asia December 2016 334 prevalence and type of OC symptoms in patients with complex partial and generalized seizure disorders and to study the association of OC symptoms with right or left sided lesions in patients with complex partial seizure (CPS).