Funding agencies This work was supported by the Royal Dutch Academy of Sciences.
Latah: An indonesian startle syndrome
Article first published online: 2 JAN 2013
Copyright © 2012 Movement Disorders Society
Volume 28, Issue 3, pages 370–379, March 2013
How to Cite
Bakker, M. J., van Dijk, J. G., Pramono, A., Sutarni, S. and Tijssen, M. A.J. (2013), Latah: An indonesian startle syndrome. Mov. Disord., 28: 370–379. doi: 10.1002/mds.25280
Relevant conflicts of interest/financial disclosures: Nothing to report.
Full financial disclosures and author roles may be found in the online version of this article.
- Issue published online: 21 MAR 2013
- Article first published online: 2 JAN 2013
- Manuscript Accepted: 17 OCT 2012
- Manuscript Revised: 29 SEP 2012
- Manuscript Received: 18 DEC 2011
- startle reflex;
- forced obedience
The nature of culture-specific startles syndromes such as “Latah” in Indonesia and Malaysia is ill understood. Hypotheses concerning their origin include sociocultural behavior, psychiatric disorders, and neurological syndromes. The various disorders show striking similarities despite occurring in diverse cultural settings and genetically distant populations. They are characterized clinically by exaggerated startle responses and involuntary vocalizations, echolalia, and echopraxia. Quantifying startle reflexes may help define Latah within the 3 groups of startle syndromes: (1) hyperekplexia, (2) startle-induced disorders, and (3) neuropsychiatric startle syndromes. Twelve female Latah patients (mean age, 44.6 years; SD, 7.7 years) and 12 age-, sex- and socioeconomically matched controls (mean age, 42.3 year; SD, 8.0) were studied using structured history taking and neurological examination including provocation of vocalizations, echolalia, and echopraxia. We quantified auditory startle reflexes with electromyographic activity of 6 left-sided muscles following 104-dB tones. We defined 2 phases for the startle response: a short latency motor startle reflex initiated in the lower brain stem <100/120 ms) and a later, second phase more influenced by psychological factors (the “orienting reflex,” 100/120–1000 ms after the stimulus). Early as well as late motor startle responses were significantly increased in patients compared with controls (P ≤ .05). Following their startle response, Latah patients showed stereotyped responses including vocalizations and echo phenomena. Startle responses were increased, but clinically these proved insignificant compared with the stereotyped behavioral responses following the startle response. This study supports the classification of Latah as a “neuropsychiatric startle syndrome.” © 2013 Movement Disorder Society