Problems with this theory are the absence of a single focus of neuronal deficit in OCD. In contrast, several regions have been implicated in OCD, including the basal ganglia, cingulate, and frontal areas,23,36 with limbic areas involved in OCD and TLE.16,18,28 The results of studies revealing a right-hemisphere TLE focus predilection, suggested an increased vulnerability to OC in this TLE population. There may be a role of AEDs in OCD, as they might convey Inhibitors,research,lifescience,medical a neuropharmacological susceptibility to OCD. Ertekin and colleagues found in their TLE patients

that most were on carbamazepine, while patients with IGE (with less OCD) were on valproate.10 This suggests that epilepsy syndrome aside, one drug might favor, or the other drug might hinder, the development of OCD. Because of the finding of depressive comorbidity with OCD in epilepsy, Inhibitors,research,lifescience,medical limbic dysfunction might represent an underlying neurobiological underpinning. Clinically, patients with OCD should therefore be assessed and find more treated for depression.10 The effects of surgery on OCD In contrast to the appearance or the worsening of OCD with Inhibitors,research,lifescience,medical temporal lobe surgery as mentioned above, a subgroup of patients with particularly temporal-lobe foci may significantly benefit from resective surgery. Surgery is also sometimes

effective in extratemporal foci, or with more widespread epileptic conditions with multiple seizure types (eg, Lennox-Gastaut syndrome), in which partial interruption of the corpus Inhibitors,research,lifescience,medical callosum may decrease certain types of seizures, particularly atonic seizures. Many types of underlying premorbid psychopathology may get worse following epilepsy surgery, even when epilepsy improves.39,43,44 There are reports of depression and psychosis, and in some cases suicide and death after temporal lobe surgery.44-47 De novo psychosis may arise,47 as well as de novo depression in 8%.45,48 Leinonen and colleagues commented on new-onset schizophrenia in a group of 57 subjects45 after surgery.

Such tendencies can be evaluated before surgery and may well factor in the Inhibitors,research,lifescience,medical decision whether to advocate this treatment in affected patients. Although Kulaksizoglu and colleagues found no particular risk factors for de novo postoperative psychiatric problems, most problems appeared to manifest within the first much 2 months after surgery40 Six of 74 patients undergoing temporal lobectomy had new-onset psychosis with 6 suicide attempts in the first month.49,50 In another series, by 6 weeks post-temporal lobectomy, of the previously nonsymptomatic patients for psychiatric disorders, half developed anxiety and depression, and almost half had emotional lability51 Other studies suggest that nondominant hemisphere surgery favors the appearance of more severe psychiatric problems,52,53 even if lesions on either side may induce OCD in nonepileptic patients.