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Coprophagia in neurologic disorders

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Abstract

We report on the unusual behavior of coprophagia (eating one’s own feces) in neurologic disorders. The Mayo Clinic Health Sciences-computerized clinical database was queried for all patients evaluated at our institution between 1995 and 2015 in which coprophagia was documented in the medical records. Twenty-six patients were identified of which 17 had coprophagia. Of the 17 patients, five were excluded due to age at onset less than 10 years, leaving 12 adult patients for this study. The median age at onset of coprophagia in the 12 patients was 55 years (range 20–88 years), and half were female. Additional behaviors were common including scatolia (fecal smearing), hypersexuality, aggression, and pica (eating objects of any kind). Coprophagia was associated with neurodegenerative dementia in six patients, developmental delay in two, and one each with seizures, steroid psychosis, frontal lobe tumor, and schizoaffective disorder. Brain imaging in the six patients with dementia showed moderate-to-severe medial temporal lobe atrophy, as well as mild frontal lobe atrophy. Autopsy examination was performed in one patient and revealed frontotemporal lobar degeneration pathology. Many different behavioral and pharmacologic therapies were implemented, yet only haloperidol was associated with discontinuation of the behavior. Coprophagia is associated with different neurologic disorders, particularly neurodegenerative dementias. The behavior may be related to medial temporal lobe atrophy, similar to the Klüver–Bucy syndrome. Haloperidol appears to be effective in treating the behavior, at least in some patients.

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Acknowledgments

We would like to acknowledge the many neurologists, psychiatrists, fellows, residents, and nurses who were involved in the documentation of coprophagia in the medial records. We would also like to acknowledge Dr. David Black, Mayo Clinic, for providing us with the MRI scans for Patient 12.

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Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Keith A. Josephs & Joseph E. Parisi

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Jennifer L. Whitwell

  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Joseph E. Parisi

  4. Department of Psychiatry, Mayo Clinic, Rochester, MN, USA

    Maria I. Lapid

Authors
  1. Keith A. Josephs
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  2. Jennifer L. Whitwell
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  3. Joseph E. Parisi
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  4. Maria I. Lapid
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Corresponding author

Correspondence to Keith A. Josephs.

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Ethical standards

All human studies have been approved by the appropriate ethics committee which is the Mayo Clinic Institutional Review Board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflicts of interest

None of the authors have any financial relationships that are in conflict with this study and there are no conflicts of interest.

Informed consent

All persons included in this study gave their informed consent prior to their inclusion in the study for their medical data to be utilized for research. Details that might disclose the identity of any of the patients included in the study have been omitted.

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Josephs, K.A., Whitwell, J.L., Parisi, J.E. et al. Coprophagia in neurologic disorders. J Neurol 263, 1008–1014 (2016). https://doi.org/10.1007/s00415-016-8096-1

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  • DOI: https://doi.org/10.1007/s00415-016-8096-1

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