Abstracts

Rationale: We describe a patient with right occipital lobe epilepsy and right mesial temporal sclerosis who experienced the onset of OCD following resection of the right hippocampus and occipital pole. Methods: A 31 year old male developed a focal and secondarily generalized seizure disorder after a mycoplasma encephalitis in the right occipital region. Seizures were refractory to multiple medication trials. MRI revealed right mesial temporal lobe sclerosis and right occipital encephalomalacia. He completed a neuropsychological evaluation, video EEG monitoring, and an intracranial electrode study for seizure localization. He then underwent resection of the right hippocampus and occipital pole. The patient reported the onset of OCD symptoms a few days following surgery, indicating that prior to surgery he only had mild anxiety concerning losing possessions but had no associated compulsions. Treatment with Zoloft reduced his motivation to perform compulsions but did not significantly impact the severity of his obsessions. Formal psychiatric evaluation was conducted 16 months after surgery while he was not receiving any psychotropic medication. The patient was administered the Structured Clinical Interview for DSM-IV-TR (SCID), Hamilton Depression Rating Scale, Yale-Brown Obsessive Compulsive Scale (YBOCS), and the Not Just Right Experiences questionnaire. Results: The SCID indicated that he fulfilled diagnostic criteria for OCD and a single past episode of Major Depressive Disorder, though he was not depressed at the time of the evaluation. Total score on the YBOCS was 24, indicating moderate symptom severity, with prominent symptoms related to contamination, washing, checking, and repeating rituals. He also reported significant problems with “not just right” experiences. He indicated spending on average four hours per day experiencing obsessions and could spend eight or more hours per day performing compulsions. He denied any history of psychiatric illness in his first degree relatives. Conclusions: To our knowledge, the present case is only the third reported of de novo onset OCD following neurosurgery for seizure disorder. Two prior such cases also occurred in the context of hippocampal resection (1 left, 1 right) but in patients with pre-existing obsessive traits.