Background: Neurological soft signs (NSSs) are defined as abnormal motor or sensory findings, including involuntary movements, a variety of dispraxia, difficulties in performing rapid alternating movements, difficulties in two-point discrimination, and graphesthesia in a person without a neurological disorder which can be determined as its focus. Aims: to investigate the relationship of NSSs with obsessive-compulsive disorder (OCD). Settings and Design: This study was designed in the Psychiatry Polyclinic of Ondokuz Mayis University Hospital. After signing an informed consent form, all the subjects were divided into 2 groups: (1) the patient group and (2) the control group. Material and Methods: Thirty consecutive patients presenting with DSM-IV OCD were included in this study. The control group consisted of 30 healthy subjects without a psychiatric/neurological disorder. All subjects underwent a physical and neurological examination for soft signs (PANESS). Statistical analysis used: The Mann-Whitney U test was used for statistical analysis of data. Results: It was seen that graphesthesia, two-point discrimination, and total PANESS scores were significantly higher in the group with OCD than the control group. In other NSSs, there was no significant difference between the patient and control groups. Conclusions: Unlike some studies, in the present study, the difference between the groups in graphesthesia compared to other NSSs was significant. The results of this preliminary study suggest that there is a relationship between NSSs and OCD. We think that NSSs may point to a structural brain abnormality in patients with OCD.
Neurological soft signs (NSSs) are defined as motor or sensory disorders (e.g. difficulties in two-point discrimination and graphesthesia), without a structural lesion in the central nervous system (CNS).[1],[2],[3],[4],[5] There are many controversial reports in the literature about the relationship of obsessive-compulsive disorder (OCD) to NSSs.[1],[2],[3],[4] Stein et al[1] found no significant differences between the patients with OCD and normal controls for both total NSS scores and sensation. Hollander et al[3] reported that there is a significant difference between patients with OCD and normal controls in total NSS scores, but not in sensory abnormalities. However, they reported that compared with other psychiatric groups, the OCD patients had more graphesthesia and involuntary movements. On the other hand, Bolton et al[2] found that sensory integration did not differ significantly in the OCD group from those in the schizophrenia group. Thus, it is also controversial whether there is a specificity of NSSs for OCD.[2],[3] Additionally, their neurological basis and etiology is still uncertain.[3]
This study aimed to investigate whether there is a significant difference between patients with OCD and healthy persons in the frequency of NSSs, especially sensorial impairment, and a role of NSSs in the pathophysiology of OCD, for example, their association with subsequent neuropsychiatric symptoms (i.e. a neuropsychiatric impairment) as to be in OCD; therefore, whether NSSs point to a structural lesion in addition to non-structural damage of the brain. We hypothesized that NSSs may point to not only a functional involvement of the brain but also to a structural lesion which cannot be showed by classical neuroimaging studies, that the affected regions of the brain for NSSs may resemble those in OCD, and that NSSs may be followed by the symptoms of OCD.
