Late onset startle induced tics

Three cases of late onset Gilles de la Tourette's syndrome are presented. The motor ties were mainly induced by an unexpected startling stimulus, but the startle reflex was not exaggerated. The ties developed after physical trauma or a period of undue emotional stress. Reflex ties may occur in Gilles de la Tourette's syndrome, but have not been described in late onset Tourette's syndrome. Such ties must be distinguished from psychogenic myoclonus and the culture bound startle syndromes.