title: Startle responses in hereditary hyperekplexia.
abstract: BACKGROUND
  Patients with hereditary hyperekplexia have excessive startle responses that are accompanied by transient stiffness and also continuous stiffness in infancy. A point of mutation has been identified for the major form of hereditary hyperekplexia in the gene encoding the alpha 1 subunit of the glycine receptor.
  
  
  OBJECTIVE
  To measure startle reflexes and autonomic responses in the major form of hereditary hyperekplexia in the original Dutch pedigree.
  
  
  METHODS
  Startle reflexes and autonomic responses were examined by administering 3 series of 20 auditory stimuli at intervals of 10 seconds (90 and 113 dB) and 60 seconds (113 dB).
  
  
  METHODS
  The Department of Neurology and Clinical Neurophysiology at the Leiden University Hospital, Leiden, the Netherlands.
  
  
  METHODS
  Nine patients with the major form of hyperekplexia and 20 healthy controls. Of the 9 patients, 5 took medication. The patients are part of the Dutch hyperekplexia pedigree.
  
  
  METHODS
  Startle responses were quantified with latency periods and areas of electromyographic bursts of the orbicular muscle of the eye, sternocleidomastoid and biceps muscles, and the thenar muscles. Autonomic reactions were measured with psychogalvanic responses and beat to beat changes of blood pressure and heart rate.
  
  
  RESULTS
  The electromyographic bursts of the 4 muscles occurred in similar order in both patients and controls. The onset of the latency periods in the patient group was significantly (P < .001) prolonged in patients who took medication. Without medication, patients had shorter latency periods of the sternocleidomastoid muscle (P = .003) than controls. The electromyographic burst occurred significantly more often in patients than in controls (P < .001). The areas of the bursts were significantly larger in patients than in controls (P < .001); the degree of habituation was significantly stronger in patients than in controls (P < .001). The amplitude of the psychogalvanic response was increased in hyperekplexia, and the degree of habituation was significantly weaker in patients than in controls. Blood pressure and heart rate did not clearly react in either group.
  
  
  CONCLUSIONS
  Motor startle responses are stronger and show more habituation in patients with hereditary hyperekplexia than in controls. The excessive responses include the psychogalvanic response. Increased responses do not necessarily indicate decreased habituation in hyperekplexia.
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Leiden University Hospital, the Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Tijssen
authors.forename: L M
authors.initials: LM
authors.lastname: Voorkamp
authors.forename: G W
authors.initials: GW
authors.lastname: Padberg
authors.forename: J G
authors.initials: JG
authors.lastname: van Dijk
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000235:genetics / Q000503:physiopathology; D004576:Electromyography; D005260:Female; D006185:Habituation, Psychophysiologic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000188:drug therapy / Q000503:physiopathology*; D010375:Pedigree; D010634:Phenobarbital; D011930:Reaction Time; D012021:Reflex, Abnormal; D013216:Reflex, Startle / Q000235:genetics
chemical_list: D010634:Phenobarbital