Amygdala dysplasia with temporal lobe epilepsy and obsessive-compulsive disorder: An fMRI/EEG study

Abstract

There is an association between temporal lobe epilepsy (TLE) and psychiatric symptoms.1 Further, seizures with affective manifestations may involve the amygdala.2 Obsessive-compulsive disorder (OCD) has been documented in patients with TLE.1,3 Here, we report the co-occurrence of TLE and OCD in a 9-year-old boy. fMRI with continuous EEG localized the seizure focus to the amygdala. Our patient is a 9-year-old boy whose only risk factor for epilepsy was a single prolonged febrile convulsion at age 30 months. At age 7 years, he had his first unprovoked generalized tonic-clonic seizure. He then had occasional simple partial seizures (SPSs), during which he felt scared; concurrently he developed OCD behaviors such as hand washing and extensive rituals associated with obsessive thoughts. He felt disturbed by the OCD symptoms but believed they would help prevent seizures. At age 8, he experienced daily SPSs and started to have complex partial seizures refractory to antiepileptic drugs. On admission at age 9, his seizures were clinically consistent with mesial temporal onset, the presence of ictal fear suggesting a seizure focus in the amygdala.2 His neurologic examination was normal. Interictal EEG documented a right anterior temporal focus. Ictal video-EEG confirmed a right temporal ictal rhythm …