Many people don’t realize that epilepsy and obsessive-compulsive disorder (OCD) — or milder obsessive-compulsive symptoms (OCS) — overlap more often than one might expect. That overlap complicates diagnosis, treatment, and quality of life. This post explores how and why these conditions intersect, what research shows, and how to approach care when they co-exist.
Epilepsy & Mental Health: Setting the Context
Living with epilepsy isn’t just about managing seizures — psychological and psychiatric comorbidities are common. An evidence review found that among people with epilepsy, clinically significant depression ranged from 4.1% to 43.4% and anxiety from 8% to 50%, both higher than general population estimates.
These comorbidities often matter more for quality of life than seizure frequency itself. It’s within this broader mental-health vulnerability that obsessive-compulsive symptoms often arise.
How Common Is OCD / OCS in Epilepsy?
Whereas general population prevalence of OCD is about 1–3% worldwide, studies in epilepsy populations show elevated rates — especially among those with drug-resistant or temporal lobe epilepsy (TLE).
One multicenter study of 221 adult epilepsy patients reported that 40.3% scored ≥ 21 on the OCD symptom inventory (OCI-R) — a threshold consistent with clinically significant OCS (Kim et al., 2019).
A 2003 review estimated that up to a quarter of patients with TLE may exhibit OCD features — symptoms such as ordering, symmetry, exactness, handwashing, or religiosity, more often than patients with idiopathic generalized epilepsy or non-epilepsy controls.
This consistent, documented association shows that OCD/OCS in epilepsy isn’t rare — but frequently underrecognized.
Why Does Epilepsy Increase Risk of Obsessive-Compulsive Symptoms?
There are several overlapping factors:
- Shared neurobiology — brain circuits. The same brain networks (limbic-frontal-thalamic circuits) that, when dysregulated, contribute to seizure activity can also underlie obsessive-compulsive symptoms. TLE particularly affects these networks.
- Seizure-related phenomena. Not all repetitive or compulsive-like behaviors in epilepsy are primary OCD. Some may be ictal or post-ictal automatisms, or consequences of altered awareness, memory, or affect after seizures. Proper evaluation — including EEG — is crucial.
- Medication effects. Certain antiseizure drugs may influence compulsive or obsessive symptoms. A 2019 Korean study found that temporal lobe seizure focus and use of drugs like lamotrigine were independently associated with higher obsessive-compulsive scores.
Diagnostic Challenges — Why OCD in Epilepsy Gets Missed
- OCS may get misinterpreted as “just part of epilepsy” (seizure-related behavior)
- Patients may not report intrusive thoughts or rituals because of shame or assumption “it’s just epilepsy.”
- Psychiatric evaluation is often overlooked during neurology visits.
- Comorbidity with anxiety/depression further complicates clarity.
As a 2004 review concluded, features such as “ordering, symmetry and exactness” are more common in epilepsy-associated OCD than “cleaning/ contamination” obsessions typical in primary OCD patients — suggesting a distinct phenotype.
Approaches to Treatment & Care When Both Epilepsy and OCD/OCS Coexist
Because seizures and obsessive-compulsive symptoms stem from overlapping but distinct mechanisms, combined, integrative care is ideal:
- Multidisciplinary evaluation. Neurologists, psychiatrists, and neuropsychologists should collaborate. Evaluate seizure history, EEG data, medication history, and psychiatric evaluation.
- Tailored medication strategies. Standard OCD treatment (like SSRIs) can be used if epilepsy is controlled. Clinicians must watch for drug interactions and effects on seizure threshold. Adjusting antiseizure therapy may also help if certain medications worsen OCS.
- Psychotherapy — CBT with ERP. Cognitive-Behavioral Therapy (especially Exposure and Response Prevention) remains gold-standard for OCD. Several case reports show good outcomes even in patients with epilepsy, when done with care and monitoring.
- Surgical / device therapy caution. For people undergoing brain surgery or neuromodulation (like RNS/DBS), psychiatric history must be considered. While neuromodulation sometimes affects mood or behavior, data are mixed and careful follow-up is essential.
- Open communication & self-advocacy. Patients and families should feel empowered to speak up about OCD symptoms — often underreported or dismissed.
Why It Matters: Beyond Seizures
Some studies show that psychiatric comorbidities (anxiety, depression, OCS) can impact quality of life more than seizure frequency itself. For teens with epilepsy, untreated OCD or OCS may worsen stress, isolation, or trigger more frequent seizures (since stress is a known seizure-precipitant). Recognizing and treating OCD isn’t a side issue — it’s central to holistic epilepsy care.
Final Thoughts: Seeing Epilepsy as More Than Seizures
The link between epilepsy and obsessive-compulsive symptoms shows that epilepsy isn’t just about electrical storms — it affects brain circuits tied to thoughts, behavior, and emotion. When seizures and mental health symptoms overlap, patients deserve integrated care, honest diagnosis, and compassionate support.
For anyone reading this: if you or a peer with epilepsy ever feel trapped by rituals, intrusive thoughts, or anxieties, know this isn’t “just you being dramatic.” It could be real — and it deserves attention. With the right team, understanding, and treatment, people with epilepsy and OCD/OCS can find balance, relief, and hope.