PubMed1994
There is no established theory on pathogenesis of Tourette's syndrome, but recently, a theory of the British school of behaviorism; 'transient tics' and the more serious case, Tourette's syndrome which ensues on the fixation of the startle reflex, have received attention. So we determined, whether pathogenesis and symptoms of Tourette's syndrome could be systematically explained by "the startle reflex theory". Authors assumed that the startle reflex was composed of two divided actions, a series of muscular movements which started with eye blinks and terminated in the flexion of lower limbs (the primary startle reflex system), and more purposeful and complicated actions which occasionally arose from these movements (the secondary startle reflex system). On the basis of this supposition, we considered simple tics which are usually called "tics", those are the manifestation of astonishment by the primary startle reflex system, and complex tics; echo phenomena, coprolalia, complex movements, and so on, which are said to be pathognomonic of Tourette's syndrome, are the expression of amazement by the secondary startle reflex system. Furthermore, we formulated a hypothesis that in the latter case, the secondary startle reflex system contains the senses of orientation and defense, and the defense mechanism which is innately imprinted in common throughout human race, and covered through individual development, is released and fixed in the form of complex movements or echo phenomena in an emergency, such as astonishment. To discuss further, we determined Latah reaction minutely (especially in "Imu" of the Ainu race in Japan) in which intricate symptoms had been suggested as one of the senses of defense, were closely related to Tourette's syndrome. For more concrete study, we presented two severe cases of Tourette's syndrome. Considering the circumstances mentioned above, pathogenesis and symptoms of Tourette's syndrome could be explained by the startle reflex theory. Finally, we analyzed several psychiatrical syndromes which were provoked by astonishment, we concluded that it was necessary to emphasize Tourette's syndrome was only a part of those more comprehensive syndromes which could be called "startle syndromes".