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Obsessive-compulsive symptoms and brain lesions compatible with multiple sclerosis.

Katharina von Zedtwitz1, Ludger Tebartz van Elst1, Horst Urbach2

  • 1Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Journal of Neural Transmission (Vienna, Austria : 1996)
|January 30, 2024
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Summary

This case study explores how autoimmune-mediated obsessive-compulsive disorder (OCD) may link to multiple sclerosis (MS). Reduced serotonin levels in cerebrospinal fluid suggest a connection between neuroinflammation and mental health in MS patients.

Keywords:
AutoimmuneCSFInflammationMultiple sclerosisOCDRIS

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Area of Science:

  • Neuroimmunology
  • Neurology
  • Psychiatry

Background:

  • Autoimmune disorders like multiple sclerosis (MS) can manifest with psychiatric symptoms, including obsessive-compulsive disorder (OCD).
  • Understanding the neurobiological underpinnings of OCD in MS is crucial for diagnosis and treatment.
  • This study presents a detailed case of a patient with both OCD and findings compatible with early-stage MS.

Observation:

  • A 42-year-old female presented with a 6-year history of OCD symptoms.
  • Magnetic resonance imaging (MRI) revealed periventricular and brainstem lesions suggestive of demyelination.
  • Cerebrospinal fluid (CSF) analysis showed elevated white blood cells, intrathecal immunoglobulin synthesis (IgG, IgM), oligoclonal bands, and a positive MRZ reaction, indicative of central nervous system inflammation.

Findings:

  • The patient was diagnosed with radiologically isolated syndrome, a pre-disease stage of MS, due to the absence of clinical attacks and MRI-based dissemination in time.
  • CSF neurotransmitter analysis revealed significantly reduced serotonin levels.
  • Despite the lack of demyelinating lesions in specific brain circuits, OCD symptoms were correlated with low intrathecal serotonin and mild neuroinflammation.

Implications:

  • Reduced serotonin levels in the central nervous system may contribute to OCD symptoms in the context of MS.
  • Further research into serotonin abnormalities in MS is warranted to elucidate the relationship between neuroinflammation and mental health disorders.
  • This case highlights the importance of considering neuroinflammatory processes in the etiology of psychiatric conditions like OCD.