Neural correlates of Obsessive – Compulsive Personality Traits in Juvenile Myoclonic Epilepsy

Abstract Objective To delineate the phenotype of juvenile myoclonic epilepsy (JME) with a focus on obsessive–compulsive personality disorder (OCPD) using multimodal psychiatric, neuropsychological, quantitative EEG (qEEG), and structural MRI markers within a predictive-processing/free-energy framework. Methods We prospectively studied 65 patients with JME and 68 matched healthy controls (HC). Participants completed DSM-IV SCID I/II interviews and a neuropsychological battery assessing working memory, psychomotor speed, mental flexibility, divided attention, inhibition, and phasic/tonic alertness; standard EEG and high-resolution structural MRI were acquired. Groups comprised HC and JME subgroups without psychiatric comorbidity, with non-OCPD Axis I/II diagnoses, and with OCPD. Welch’s t-tests (FDR-corrected) and Hedges’ g quantified neuropsychological and alpha-band coherence differences. Surface-based analyses assessed cortical thickness/surface area. Exploratory regressions tested associations of OCPD, seizure freedom, and antiseizure medication (ASM) load with cognition; Kendall’s tau tested coherence–cognition associations. Results Compared with HC, JME showed broad executive–attentional impairment, most pronounced in patients with psychiatric comorbidity. The OCPD subgroup exhibited particularly large slowing in psychomotor speed, inhibition (reaction time), and tonic alertness versus HC, while OCPD versus non-OCPD JME differences did not survive multiple-comparison correction. qEEG showed increased interhemispheric frontal and decreased temporal alpha coherence in JME, with temporal hypo-coherence strongest in those with psychiatric comorbidity; within JME, OCPD was linked to increased left fronto-temporal alpha coherence. In the MRI subsample, JME-OCPD demonstrated increased cortical thickness in left medial orbitofrontal and anterior cingulate regions (vs HC and vs JME without OCPD) and additional posterior occipito-temporal clusters versus HC. Regression and coherence–cognition associations were weak and non-significant after FDR correction. Significance JME features syndrome-level executive–attentional dysfunction and altered fronto–temporal network organization. Comorbid OCPD marks a subgroup with accentuated cognitive slowing and distinct medial prefrontal/cingulate structural and left fronto-temporal connectivity signatures, aligning with predictive-processing accounts of rigid, over-precise high-level priors. Key points JME is linked to broad executive–attentional impairment versus healthy controls. Psychiatric comorbidity amplifies cognitive deficits in JME. JME with OCPD shows particularly large slowing/inhibitory-control deficits versus controls, while OCPD vs non-OCPD differences within JME are modest. Alpha-band EEG coherence indicates altered network organization in JME and an OCPD-related increase in left fronto–temporal coherence within JME Surface-based MRI suggests an OCPD-related structural phenotype in JME, involving medial orbitofrontal/anterior cingulate cortical thickening