Dr. Ed. Remouchamps (Ned. Tijdschr. v. Geneesk, No. 12, 1895, p. 539) relates a case of convulsive tic, one interesting feature of which was the development from purely motor symptoms of subacute mania. Earlier writers on this subject (Gilles de la Tourette, Frylinck, etc.) make no mention of psychic disturbances, and others more recently (Buringh Boekhoudt and Van der Weyde) have noted the presence of imperative ideas which are said frequently to occur in these subjects, but that apart from this they betray no mental abnormalities, except after a long continuance of the original affection. Guinon (Rev. de Méd., 1886, p. 51) and Oppenheim (Berl. Klin. Wochenschr., 1889, No. 25) have recorded the occasional occurrence of imperative ideas, and Séglas (Bull. de la Soc. de Méd. Ment. de Belgique, 1887) and Stembo (Berl. Klin. Wochenschr., 1891, No. 28) have noted various intellectual disturbances. The case here detailed presented certain abnormal features. The motor attack first showed itself at a comparatively late age (54). There were no antecedent evidences of involuntary movement (tics vulgaires), and its onset, occurring at the menopause, was sudden, and not, as is usually the case, of gradual growth. The progressive development was rapid, and after a comparatively short duration (two years) led on to psychic disturbance. Hysterical symptoms (globus, bulimia, abdominal and diaphragmatic clonic contractions) accompanied the earlier tic symptoms. The maniacal symptoms rapidly vanished under asylum treatment, and after two months the patient was discharged, with a marked improvement, too, in the symptoms of her primary neurosis. Buringh Boekhoudt and Van der Weyde in endeavouring to explain the phenomena of this malady observe that, taking into consideration the rapidity of succession of movements and vowel sounds, these must in a measure be rendered unconsciously. They are of opinion that some alteration must exist in those inhibitory tracts the office of which is to control and modify verbal and motor representations in their transmission to motor initiatory centres. As children learn to speak by imitation, they assume that the disposition to convert speech (or motor) idea into speech (or motor) action is an innate one, and that thus “every person is a born echolaliac.” This leads one to the idea that convulsive tic and its correlated disorder latah, may be the evidence of a developmentary reversion, the affections being closely allied to the microkinetic movements of infants. It must be noted that in certain cases the idea (of phonation or movement) must exist for a definite period in the field of consciousness, as the patients have a premonition of what they are about to say or do. The instance quoted by Frylinck from Guinon of the ballet-dancer who never was subject to involuntary grimacing coram publico, but who on retiring immediately commenced violent facial contortions, proves that for a time these movements can be supervised and controlled without intentional will effort. As every cerebral performance of whatever nature acts as a stimulant to its repetition, we can understand how these movements may become reflex, and thus ensue in rapid succession outside the limit of conscious feeling. It is not, however, all movements or sounds that are reflections of recently-observed movements or sounds, but also from earlier cerebral acceptations of such can they arise, probably as the result of some unknown cortical irritation. The development of such irritation or its intensification may then lead to disturbances of the psychic centres.
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