OCD and Epilepsy: Understanding the Relationship

Being a perfectionist and wanting to give your best effort while avoiding errors and mistakes or finding comfort in certain rituals or routines does not automatically mean you have obsessive-compulsive disorder (OCD). These behaviors, for some, are simply personality traits and coping mechanisms. While the term, “OCD” is sometimes used to judge, label, or belittle someone, this is a real mental condition that for many is life-altering.

There are many facets and causes of OCD but most researchers agree that the brain plays a role in development and progression of it. Because OCD has a brain component, and shares some symptoms with other neurological conditions, like epilepsy, people with OCD and epilepsy are increasingly exploring the connection between two conditions in the hope that they can better understand them.

If you are wondering if epilepsy is linked to OCD, and how these two conditions are connected, you have come to the right place. In this article, we will help you better understand epilepsy and OCD by exploring what epilepsy is, what OCD is, and how the two conditions are related. We will also discuss some treatments that can help people with an OCD and epilepsy comorbidity.

What is OCD?

Obsessive-compulsive disorder or OCD is a common type of anxiety disorder that involves obsessive or intrusive thoughts and compulsive behaviors or repetitive rituals or routines. Obsessions involve non-stop unwanted and upsetting thoughts, urges, visions, fears, worries, and emotions, while compulsions involve rituals or routines like repetitive hand-washing, counting, checking, etc.

Compulsions are behaviors or actions that are repeated over and over again. An example of a compulsion is reading a sentence over and over again (reading OCD) because you are afraid of missing a word, or saying the word wrong. You keep reading the sentence over and over again until you feel satisfied that you have read the sentence correctly.

Re-reading the sentence provides you with a relief from the stress and anxiety you feel at the thought of “missing something” or “reading something wrong.” Compulsions are meant to ease the stress and anxiety caused by the intrusive thoughts, fears, urges, etc. However, this relief is only temporary. In other words, it could be triggered again when you start to read something.

There are many types of OCD such as reading OCD, racism OCD, hoarding OCD, relationship OCD, and contamination OCD. While there is no “cure” for this mental health condition with the right OCD treatment, you can reduce the frequency and severity of your OCD symptoms.

What is Epilepsy?

Epilepsy, also known as a seizure disorder, is a common neurological (brain) condition that causes recurring seizures. Approximately 1% of people in the US currently live with epilepsy. Researchers suggest that changes in brain activity can trigger epilepsy, which means that any part of the brain can cause seizures.

Like OCD, there are many different types of epilepsy. For some there is an identifiable cause, but for others, there is not. Also, like OCD, epilepsy does not discriminate. It can affect anyone, regardless of gender, race or ethnicity, educational background, socioeconomic status, health, or age.

Epilepsy symptoms vary from person-to-person. For some, this condition manifests as a loss of awareness (i.e., a blank stare for several seconds-to-minutes), while for others, it involves repeatedly moving their arms or legs (i.e. convulsions). It can also cause repetitive movements like “wringing” one’s hands, making chewing motions, excessively swallowing, or twirling or walking in circles.

Keep in mind that engaging in repetitive behaviors (i.e., flapping or jerking arms or legs) does not automatically mean that you have this condition. Epilepsy is characterized as having two unprovoked seizures (at minimum) at least 24 hours apart. Thus, having one unprovoked seizure is usually not enough to diagnose epilepsy. Unprovoked seizures typically do not have a clear-cut cause.

What Causes Epilepsy?

Epilepsy can be caused by a number of factors, such as:

• Genes

Researchers have found that some types of epilepsy are hereditary (run in families). In other words, there appears to be a genetic component to epilepsy. 

• Environmental Factors

Studies suggest that environmental factors (i.e., toxins) may also play a role in the development and progression of epilepsy. 

• Head Trauma

Head trauma or injuries to one’s brain due to a car accident or traumatic fall may trigger epileptic seizures. 

• Brain Tumors, Blood Vessel Conditions, or Strokes

Brain tumors can alter the way the brain functions leading to epileptic seizures. Additionally, blood vessel conditions, like arteriovenous malformations and cavernous malformations, can experience seizures. Also, people over the age of 35 who have had a stroke have a heightened risk of epilepsy. 

• Infections and Diseases 

Infections and diseases like meningitis, HIV, viral encephalitis and some parasitic infections can trigger epilepsy in some people. 

• Pre-Birth Injuries

Babies, in the womb, are especially sensitive to brain damage caused by their mother’s infection, poor nutrition, or not enough oxygen. This can cause brain damage that leads to epilepsy.

• Development Conditions 

Studies suggest that people with autism are more likely to experience epilepsy than people who do not have autism. Research also found that people with epilepsy have an elevated risk of developing attention-deficit hyperactivity disorder (ADHD) or another developmental condition.

What Are The Most Common Seizures Linked to Epilepsy?

Epilepsy involves 9 types of seizures:

• Temporal Lobe Seizures

Temporal lobe seizures occur in your temporal lobes, brain regions responsible for processing your emotions and helping you store short-term memories. 

Many people who have temporal lobe seizures experience an aura and sudden emotions like sadness, anxiety, stress, fear, or happiness. A temporal lobe seizure can cause you to become unaware of your surroundings. It can also cause you to stare into space, smack your lips, excessively swallow or chew or repeatedly move your fingers.

• Frontal Lobe Seizures

Frontal lobe seizures start in the frontal lobe or the front part of your brain. This brain region is responsible for controlling movement. People who experience frontal lobe seizures tend to move their eyes and head (in general) to the right or life (one side). They also do not respond to commands or when spoken to. 

Additionally, many of these individuals tend to scream, cry, or laugh during the seizure. Some epileptics who experience frontal lobe seizures may engage in repetitive movements like swinging their arms, rocking back-and-forth, twirling in circles, flapping arms and legs, bicycle pedaling, etc. 

• Occipital Lobe Seizures

Occipital lobe seizures begin in the occipital lobe, the part of the brain that controls your vision and how you see things. People who experience these types of seizures tend to have hallucinations. Some also lose part or all of their vision during the seizure. Occipital lobe seizures can cause excessive or repetitive eye blinking or movements. 

• Absence Seizures

Children are most at risk for experiencing absence seizures or petit mal seizures). Symptoms typically include blank expressions “staring into space” that may be accompanied by repetitive or excessive eye-blinking or lip-smacking that lasts about 5 to 10 seconds. Children who experience absence seizures may experience 100 episodes a day with some temporarily losing consciousness.

• Tonic Seizures

Tonic seizures can cause stiff muscles. It can also cause a loss of consciousness in some people. These seizures typically affect your back, arms, and legs muscles, causing you to fall to the ground.

• Atonic Seizures

Atonic seizures (drop seizures) typically cause a loss of muscle control in the legs, leading to sudden falls. 

• Clonic Seizures

Clonic seizures are linked to repetitive or rhythmic jerking in the neck, face, and arms muscle movements.

• Myoclonic Seizures

Myoclonic seizures involve sudden and brief upper body, arms and legs twitching and jerking.

• Tonic-Clonic Seizures

The most dangerous and frightening epileptic seizures are tonic-clonic seizures (grand mal seizures). Symptoms associated with these types of seizures include a sudden loss of consciousness, body-stiffening, twitching, tongue-biting, and shaking movements.

Is There a Relationship Between Epilepsy and OCD?

Possibly. The jury is still out.

People with epilepsy are twice as likely to develop OCD than the general population. This is especially true when it comes to temporal lobe epilepsy, however the reason for this elevation is unknown. One earlier study found that brain damage caused by epileptic seizures can alter brain connections, chemistry, and function, causing OCD symptoms, such as excessive and repetitive blinking or hand-wringing (compulsions).

Keep in mind, however, for some people with epilepsy, rituals and routines become an integral part of their life – a way to help with memory loss which can sometimes go hand-in-hand with epileptic seizures.

Also, understand that while seizures can affect short-term memory, it can impact long-term memory and the ability to recall information as well. This explains why some people with this condition struggle to remember important information, such as birthdays, anniversaries, doctor’s appointments, childhood memories, etc.

It can also cause memory challenges when it comes to everyday tasks such as remembering to take your medication, which if missed could trigger or worsen epileptic seizures. That is why it is important for these individuals to develop rituals or routines – to help them remember things they may have forgotten due to the seizures. Understand, however, that unlike OCD, these rituals or routines are not linked to obsessions.

And, while people with epileptic compulsions may be performed to ease the stress and anxiety of not being able to remember things, the intent behind it is not the same for someone with OCD, who is doing it to ease the stress and anxiety associated with obsessions. So, ultimately, most people with epilepsy are able to manage these rituals and routines without developing OCD.

OCD symptoms encompass a variety of neurological conditions, which may or may not involve epilepsy. What does that mean? It means any person with a condition that affects the basal ganglia (i.e. Parkinson’s disease, progressive dementia, Tourette’s syndrome, and Huntington’s disease) is at risk of experiencing OCD.

Could that also include epilepsy? Absolutely because it is a neurological condition. Head injuries (which is also a possible cause of epilepsy) can increase your risk of developing OCD. So while some researchers believe that epilepsy is strongly linked to OCD, others believe that this link is weak at best. According to critics, while there may be a weak link between epilepsy and OCD, it is unlikely for people with OCD to also develop epilepsy. When OCD is detected in people with epilepsy, it tends to be in those who have experienced complex partial seizures located in the temporal or frontal lobe, or seizures located in the anterior cingulate gyrus (near the corpus callosum).

What Does The Research Say?

Although the exact link between OCD and epilepsy is unclear, there is some convincing evidence that there is some type of link – even if it is a weak (or unknown) correlation.

According to early studies, epilepsy may be linked to certain personality traits (i.e., obsessional ones). Researchers found that people who struggle with a personality disorder have an increased risk of also developing epilepsy. Conversely, other studies suggest that epilepsy may be linked to illogical thinking patterns and/or behaviors.

According to a 1975 article by Waxman and Geschwind, there may be a direct link between temporal lobe epilepsy and a Geschwind personality/behavioral syndrome. People who have this behavioral syndrome typically exhibit obsessional personality traits. As a result, the researchers theorized that OCD could arise due to personality characteristics linked to epilepsy.

Some 80s and 90s studies found an indirect link between OCD and epilepsy. However, most of the evidence associating OCD with epilepsy has originated from anecdotal evidence, clinical observations, and case studies – not from large-scale research studies. The majority of people with epilepsy (who also struggle with OCD) report only developing OCD symptoms after being diagnosed with the condition and experiencing seizures.

Some have suggested that in some people with epilepsy, OCD may be a form of “forced thinking,” new thoughts that intrude into the patient’s awareness at the onset of a seizure. This behavior may also occur without seizure activity. Some investigators have tried to use the connection of OCD with epilepsy to look for information about the mechanisms underlying each disorder.

Understand that OCD symptoms appear to be more common in people who struggle with a neurological condition like epilepsy as compared to the general population. According to a study, approximately 25% of people with temporal lobe epilepsy also have OCD. Another theory associated with OCD and epilepsy suggests a “kindling effect,” an effect that occurs when seizures in one part of the brain trigger seizures in another part of the brain, triggering OCD symptoms.

Some evidence points to epileptic seizures in the frontal lobe may trigger seizures in the limbic brain regions, increasing their risk of OCD symptoms. Similarly, researchers suggest there may be a link between OCD and left cerebral hemisphere seizures, but more research is needed to determine the validity of these theories and findings.

How is OCD and Epilepsy Commodity Treated?

Like OCD, there is no known “cure” for epilepsy, however, there are ways that both conditions can be effectively treated and managed. OCD and epilepsy can be treated simultaneously (at the same time) with a variety of tools, resources, and approaches, such as psychotherapy, medications, surgery, seizure devices, implants, and a specialized diet. 

Psychotherapy 

The therapies for OCD and epilepsy are the same: cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), and dialectical behavioral therapy (DBT). These therapies can help ease stress and anxiety, get to the root of your OCD symptoms, help you change how you view the conditions and their associated symptoms, and teach you healthy coping skills and strategies that can be applied to both conditions. 

Medications 

The two most common medications used to treat OCD and epilepsy are Buspar and Lyrica. These medications are typically only prescribed when psychotherapy is ineffective. 

• Buspar (Buspirone) is one of the most common medications used to treat anxiety disorders, like OCD, when epilepsy is involved. Buspar works by increasing dopamine and serotonin in your brain. 

Dopamine and serotonin help calm your mind and balance your mood, thereby reducing stress and anxiety – triggers and symptoms of OCD. While the most common medication used to treat OCD, in general, is SSRI antidepressants, the effects of antidepressants on OCD is unknown, so it should be avoided, if possible. 

• Lyrica (Pregabalin) is an anticonvulsant designed to calm the damaged, irritated, or overactive nerves that are triggering the seizures. Pregabalin is the only antiepileptic medication licensed to treat both anxiety and epilepsy.

Specialized Diet 

Certain foods (vitamins and minerals) and a healthy diet are believed to help ease or reduce OCD symptoms and epileptic seizures. The theory is that a healthy body complete with the essential nutrients can help balance hormonal levels that are deficient. 

Remember, low levels of dopamine and serotonin are linked to mental health conditions, like OCD, and physical health conditions like epilepsy. The most common epileptic diets include: ketogenic diet (a very high-fat, low-carb diet), MCT diet (A keto diet consisting of only medium-chain triglycerides (fats)), MAD diet (A high-fat, low-carb Atkins diet that allows you to have unlimited amounts of protein, and LGIT or low glycemic index treatment (allows carbs that have a lower impact on your blood sugar levels (i.e., fiber)

Novel Treatments

• Drug-Induced Seizures

A case study found that some people who struggle with OCD and epilepsy may benefit from drug-induced seizures. In this case study, the individual’s OCD symptoms and seizures greatly improved after experiencing drug-induced seizures. This finding suggests that convulsions may be a viable alternative treatment for OCD sufferers with or without epilepsy. 

• Brain Implants

According to researchers, brain implants may be a viable treatment option for people struggling with OCD and epileptic seizures. This procedure involves using one electrode to target two portions of the brain so both the parts of the brain linked to OCD and the ones linked to epilepsy are addressed at the same time. 

• Neurostimulation System (RNS) Treatment

Studies indicate that responsive neurostimulation system (RNS) treatment can calm the brain and help control convulsions common in epilepsy. During RNS, electrical pulses are delivered to the brain to help “normalize” the brain activity causing the seizures. 

• Responsive Deep Brain Stimulation

Studies indicate that responsive deep brain stimulation (rDBS) can offer people with OCD quick-acting, strong, and long-lasting improvement with their obsessions and compulsions. Approximately 25% refractory temporal lobe epilepsy struggle with OCD features, which often go misdiagnosed or unrecognized. 

Researchers also found that obsession features, especially those focused on symmetry or ordering, exactness, checking, handing-washing, and religiosity, tend to occur in OCD sufferers in people with right- or left-sided epileptic foci as compared to those with idiopathic generalized epileptic controls. 

Studies suggest that neurobiological abnormalities and social factors suggest involving the frontal-thalamic-pallidal-striatal-anterior cingulate-frontal circuits (stemming certain diseases or damage) may benefit from surgery and stimulation (electrical pulses) may reduce OCD in people with temporal lobe epilepsy.

• Self-Help Tools, Natural Remedies, and Holistic Treatments

Many self-help tools, natural remedies, and holistic OCD treatments can also be effective for epilepsy, primarily because the goal of them is to calm or “quiet” the mind. The result? Fewer OCD symptoms and seizures.

Mindfulness meditation, hypnosis, probiotics, aromatherapy, homeopathy, service dogs, art therapy, CBD, yoga, regular exercise, herbal remedies like St. John’s Wort and milk thistle, and essential oils, along with Impulse Therapy, an online OCD recovery treatment program – are alternative treatments that can help you manage both your OCD and epilepsy symptoms.

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