Roth Robert M, Jobst Barbara C, Thadani Vijay M, Gilbert Karen L, Roberts David W
Department of Psychiatry, Neuropsychology Service, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756-0001, USA.
Epilepsy Behav. 2009 Apr;14(4):677-80. doi: 10.1016/j.yebeh.2009.01.011. Epub 2009 Feb 8.
A 31-year-old man with medication-refractory seizures in the context of right mesial temporal lobe sclerosis and right occipital encephalomalacia is described. He experienced the onset of obsessive-compulsive symptoms following resection of the right hippocampus and right occipital pole. Semistructured psychiatric evaluation was conducted 16 months after surgery. Results indicated that he fulfilled diagnostic criteria for obsessive-compulsive disorder (OCD) and that he was not depressed at the time of the evaluation. Total score on the Yale-Brown Obsessive Compulsive Scale was 24, indicating moderate symptom severity, and he had prominent symptoms related to contamination, washing, checking, repeating rituals, and ordering. He also reported significant problems with "not just right" experiences. Treatment with sertraline resulted in apathy. To our knowledge, the present case is only the fourth reported of de novo onset OCD following neurosurgery for seizure disorder, and the first in a patient without either preexisting obsessive traits or an OCD spectrum disorder.
本文描述了一名31岁男性，患有右侧内侧颞叶硬化症和右侧枕叶脑软化症，药物治疗难治性癫痫发作。他在右侧海马体和右侧枕叶切除术后出现强迫症状。术后16个月进行了半结构化精神科评估。结果表明，他符合强迫症（OCD）的诊断标准，且评估时未患抑郁症。耶鲁-布朗强迫症量表总分24分，表明症状严重程度为中度，他有与污染、清洗、检查、重复仪式动作和整理相关的突出症状。他还报告了“感觉不对”体验方面的显著问题。舍曲林治疗导致冷漠。据我们所知，本病例是第四例报道的癫痫症神经外科手术后新发强迫症病例，也是首例既无既往强迫特质也无强迫症谱系障碍的患者。
