Brain Advance Access originally published online on October 21, 2003
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Brain, Vol. 127, No. 1, 143-153, 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh015
The structural brain correlates of neurological soft signs in ÆSOP first-episode psychoses study
1 Division of Psychological Medicine, 2 Department of Neurology and 3 Section of Social Psychiatry, Institute of Psychiatry, King’s College London, 4 Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK, 5 Department of Psychiatry, Sir Charles Gairdner Hospital, Perth, Australia and 6 Department of Psychiatry, University of West Indies, Trinidad, Trinidad and Tobago
Correspondence to: Paola Dazzan, Division of Psychological Medicine, Box 63, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK E-mail: spcbpad{at}iop.kcl.ac.uk
Patients with schizophrenia and related psychoses have an excess of minor neurological abnormalities (neurological soft signs) of unclear neuropathological origin. These include poor motor coordination, sensory perceptual difficulties and difficulties in sequencing complex motor tasks. Neurological soft signs seem not to reflect primary tract or nuclear pathology. It still has to be established whether neurological soft signs result from specific or diffuse brain structural abnormalities. Studying their anatomical correlates can provide not only a better understanding of the aetiopathogenesis of soft signs, but also of the pathophysiology of schizophrenia. Surprisingly few studies have investigated the brain correlates of neurological soft signs. In the present study, we investigated the relationship between brain structure and neurological soft signs in an epidemiologically based sample of 77 first-episode psychosis patients. We used the Neurological Evaluation Scale for neurological assessment and high-resolution MRI and voxel-based methods of image analysis to investigate brain structure. Higher rates of soft neurological signs (both motor and sensory) were associated with a reduction of grey matter volume of subcortical structures (putamen, globus pallidus and thalamus). Signs of sensory integration deficits were additionally associated with volume reduction in the cerebral cortex, including the precentral, superior and middle temporal, and lingual gyri. Neurological soft signs and their associated brain changes were independent of antipsychotic exposure. We conclude that neurological soft signs are associated with regional grey matter volume changes and that they may represent a clinical sign of the perturbed cortical–subcortical connectivity that putatively underlies psychotic disorders.
Key Words: neurological soft signs; first-episode psychosis; magnetic resonance imaging; voxel-based morphometry; basal ganglia
Abbreviations: EPS = extrapyramidal symptoms; NART = National Adult Reading Test; NES = Neurological Evaluation Scale; NSS = neurological soft signs
Received May 29, 2003. Revised July 9, 2003. Accepted July 30, 2003.
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