Brain Advance Access published online on October 21, 2003
Brain, doi:10.1093/brain/awh015
© 2003 by Guarantors of Brain
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Article
1 Division of Psychological Medicine, King's College, London, UK
* Corresponding author. E-mail: spcbpad{at}iop.kcl.ac.uk.
Received 9 May 2003
; revised 9 July 2003
; accepted 30 July 2003
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.
Keywords: neurological soft signs; first-episode psychosis; magnetic resonance imaging; voxel-based morphometry; basal ganglia
The structural brain correlates of neurological soft signs in ÆSOP first-episode psychoses study
2 Department of Psychiatry, Sir Charles Gairdner Hospital, Perth, Australia
3 Department of Psychiatry, University of West Indies, Trinidad, Trinidad and Tobago
4 Department of Neurology, King's College, London, UK
5 Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
6 Section of Social Psychiatry, Institute of Psychiatry, King’s College London, UK
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