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LETTER TO EDITOR |
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| Year : 2006 | Volume
: 9
| Issue : 3 | Page : 183 |
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Psychiatric symptoms in neurological practice: Comment on herpes simplex encephalitis and obsessive- compulsive disorder
M Gourie-Devi
Institute of Human Behaviour and Allied Sciences, Department of Neurophysiology and Neurology, Sir Gangaram Hospital, New Delhi, India
Correspondence Address:
M Gourie-Devi
Institute of Human Behaviour and Allied Sciences, Department of Neurophysiology and Neurology, Sir Gangaram Hospital, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-2327.27666
How to cite this article:
Gourie-Devi M. Psychiatric symptoms in neurological practice: Comment on herpes simplex encephalitis and obsessive- compulsive disorder. Ann Indian Acad Neurol 2006;9:183 |
How to cite this URL:
Gourie-Devi M. Psychiatric symptoms in neurological practice: Comment on herpes simplex encephalitis and obsessive- compulsive disorder. Ann Indian Acad Neurol [serial online] 2006 [cited 2021 Apr 13];9:183. Available from: https://www.annalsofian.org/text.asp?2006/9/3/183/27666 |
Sir,
I read with interest the comprehensive review article by Madhusudanan[1] focusing on a range of psychiatric symptoms occurring in neurological disorders and the underlying neuroanatomical, neurophysiological and neurobiochemical basis of these symptoms. The author has enumerated a number of neurological disorders associated with obsessive-compulsive disorders (OCD) in Table 6 and also suggested that there is a role of streptococcal infections either in the initiation or exacerbation of OCD in children. However there is no mention of association of herpes simplex virus (HSV) with obsessive-compulsive disorders. In studies from India, Khanna et al . observed that in patients with OCD, the titre of IgG viral antibodies for HSV1 was significantly higher compared to the controls in sera[2] and in cerebrospinal fluid[3] and further the serum: CSF ratio was suggestive of intrathecal synthesis HSV1 specific IgG. To further test the hypothesis of association of HSV with OCD we extended the work to assess the presence of obsessive- compulsive (OC) symptoms in subjects who had survived an episode of herpes simplex encephalitis (HSE) and were under follow up.[4] Two of five patients had mild OC symptoms on Leytons' obsessional inventory and Yale Brown Obsessive- Compulsive scale, but did not have clinical OC disorder. In two other patients, soon after recovery from HSE the presenting feature was OCD and the disturbing compulsive behaviour improved on treatment with selective serotonin reuptake inhibitors.[4] It may be postulated that this association of HSE and OCD may be either due to shared neuroanatomical or shared neuropsychological deficits or both. Limbic system and the entire limbic cortex, anterior and inferior temporal lobe and frontal structures are known to be involved in herpes simplex encephalitis and HSV1 antigen has also been found to be concentrated in these regions.[5],[6],[7] Based on neuropsychological and functional imaging studies similar areas have been shown to be involved in OCD.[8],[9] Thus it is important to recognize that in herpes simplex encephalitis, obsessive-compulsive disorders may occur with greater frequency than expected and this has become particulary relevant with the availability of specific antiviral treatment and consequent improvement of survival rate.
| References | |  |
| 1. | Madhusudanan M. Psychiatric symptoms in neurological practice. Ann Indian Acad Neurol 2006;9:72-89.  |
| 2. | Khanna S, Ravi V, Shenoy PK, Chandramukhi A, Channabasavanna SM. Viral antibodies in blood in obsessive compulsive disorder. Indian J Psychiatr 1997;39:190-5. |
| 3. | Khanna S, Ravi V, Shenoy PK, Chandramukhi A, Channabasavanna SM. Cerebrospinal fluid viral antibodies in obsessive-compulsive disorder in an Indian population. Biol Psychiatr 1997;41:883-90. |
| 4. | Khanna S, Bhat M, Pavan Kumar M, Ravi V, Satishchandra P, Gourie-Devi M. Obsessive compulsive symptoms in herpes simplex encephalitis. Ann Indian Acad Neurol 2001;4:65-70. |
| 5. | Damasio AR, van Hoesen GY. The limbic system and localization of herpes simplex encephalitis. J Neurol Neurosurg Psychiatr 1985; 48:297-301. |
| 6. | Kapur N, Barker S, Burrows EH, Ellison D, Brice J, Illis LS, et al . Herpes simplex encephalitis: Long term magnetic resonance imaging and neuropsychological profile. J Neurol Neurosurg Psychiatr 1994;57:1334-42. |
| 7. | Esri MM. Herpes simplex encephalitis: An immunohistological study of the distribution of viral antigen within the brain. J Neurol Sci 1982;54:209-26. |
| 8. | Trivedi MH. Fuctional neuroanatomy of obsessive-compulsive disorder. J Clin Psychiatry 1996;57:26-36. [PUBMED] |
| 9. | Hugo F, van Heerden B, Zungu-dirwayi, Stein DJ. Functional brain imaging in obsessive-compulsive disorder secondary to neurological lesions. Depress Anxiety 1999;10:129-36. |
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