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Latah: An indonesian startle syndrome

Authors

  • Mirte J. Bakker PhD,

    1. Department of Neurology and Clinical Neurophysiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
    2. Department of Clinical and Health Psychology, University of Utrecht, Utrecht, the Netherlands
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  • J. Gert van Dijk MD, PhD,

    1. Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden, the Netherlands
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  • Astuti Pramono,

    1. Neuropediatric Department, Sardjito General Hospital, Gadjah Mada University, Jogjakarta, Indonesia
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  • Sri Sutarni,

    1. Neuropediatric Department, Sardjito General Hospital, Gadjah Mada University, Jogjakarta, Indonesia
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  • Marina A.J. Tijssen MD, PhD

    Corresponding author
    1. Department of Neurology, University Medical Centre Groningen (UMCG), University of Groningen, Groningen, the Netherlands
    • Department of Neurology and Clinical Neurophysiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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  • Funding agencies This work was supported by the Royal Dutch Academy of Sciences.

  • 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.

Correspondence to: Prof. Marina A.J. Tijssen, Movement Disorders, Department of Neurology AB 51, University Medical Centre Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, the Netherlands; m.a.j.de.koning-tijssen@umcg.nl

Abstract

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

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