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Obsessive-compulsive disorder in outpatients with epilepsy: prevalence and clinical features

Ali Savaş Çilli, Faruk Uğuz, Esra Zeytinci, Behiç Seren, Emine Genç, Bülent Oğuz Genç.

Objective: In the present study, we aimed to investigate the prevalence and symptomatology of and factors associated with obsessive-compulsive disorder in epilepsy patients.

Methods: A total of 155 consecutive patients with epilepsy between ages 18 and 60, who presented to epilepsy outpatient clinic of a university hospital were included in this study. Patients with additional neurological disorders other than epilepsy; epilepsy secondary to head trauma, metabolic disorders, and intracranial problems; patients with severe medical diseases; mental retardation, and patients who received psychotropic medications during the last month were excluded from the study.

Sociodemographic properties of patients, type of epilepsy, and antiepileptic medications were recorded. Types of epilepsy were recorded clinically as simple partial, complex partial, juvenile absence, juvenile myoclonic, generalized tonic-clonic, and others. Type of epilepsy according to EEG was recorded as temporal lobe epilepsy and non-temporal lobe epilepsy. SCID-I (Structured Clinical Investigation of Disease) for axis I was used to diagnose OCD for DSM-IV. Yale-Brown Obsession Compulsion Scale was used for the types of obsessions and compulsions among the OCD diagnosed patients.

Results: Nine (5.8%) patients met the criteria for OCD. The most common obsessions were contamination (66.7%), aggression (44.4%), religious (22.2%) and symmetry/exactness (22.2%) whereas the most common compulsions were cleaning/washing (66.7%), checking (66.7%), repeating rituals (22.2%) and orderliness/sorting (22.2%), respectively. Patients with temporal lobe epilepsy had a higher frequency of OCD than patients with non-temporal lobe epilepsy. The correlation between levetiracetam use and OCD was found to be marginally significant. No correlation was detected between OCD and other anticonvulsants.

The mostly used anticonvulsants were oxcarbazepine (35.5%), carbamazepine (31.6%) and valproic acid (34.2%). The most frequent clinically diagnosed epilepsy types were generalized tonic-clonic (34.2%) and complex partial epilepsy (27.1%). Twenty five patients had temporal lobe epilepsy (16.1%) and others had nontemporal epilepsy (83.9%).

There were no difference between the groups regarding age, sex, duration of illness, education level, marital status, and anticonvulsant use. Prevalence of OCD was 10.5% (n=2) among the patients with juvenile myoclonic seizures, 9.5% (n=4) with complex-partial and 5.7% (n=3) with generalized tonic-clonic seizures. OCD was not diagnosed among the patients with other types of epilepsy. However, there was no significant relation between clinically diagnosed type of epilepsy and the prevalence of OCD. Prevalence of OCD was higher among the patients with temporal lobe epilepsy (16%) than nontemporal lob epilepsy patients (3.8%).

Conclusion: The results suggest that the prevalence of OCD among a group of outpatients who are in treat

Key words: Obsessive compulsive disorder, epilepsy, outpatients, prevalence

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