Startle Disease and Genes | Action Medical Research | Children's Charity | Children's Charity

Startle disease: hunting down elusive genes

First published on 18 January 2012

Updated on 20 October 2016

What did the project achieve?

“We’ve discovered new genetic causes of a rare condition called startle disease, which affects newborn babies,” says Professor Robert Harvey of University College London.

Babies with startle disease become rigid and unable to move when startled. They sometimes stop breathing, which can prove fatal. Some babies have mild learning disabilities too.

“Our findings had an immediate impact on many of the families who took part in our research, as we gave them a definitive genetic diagnosis,” says Professor Harvey. “Worldwide, the number of laboratories offering genetic tests for startle disease has increased. Our work also revealed further genetic changes that might explain more cases of startle disease, which we are investigating further.”

“A definitive genetic diagnosis gives families an explanation for their child’s problems and helps identify babies who are at increased risk of having learning difficulties and breathing problems,” says Professor Harvey. “This helps ensure babies get the right drug treatment, which can reduce symptoms. It enables more accurate predictions of babies’ future educational needs, which can help them to gain access to appropriate support. And for babies who are at greatest risk of breathing problems, closer monitoring of heart rate and breathing, and training parents in resuscitation techniques, could prove life-saving.”

This research was completed on 28 February 2014

Babies with a rare illness called startle disease react in an exaggerated way when startled – by a loud noise, for example. They become rigid and unable to move, and sometimes stop breathing, which can prove fatal. Professor Robert Harvey of the UCL School of Pharmacy, London, and Professor Mark Rees and Dr Rhys Thomas at the Institute for Life Science, Swansea, are looking for more of the genes that cause startle disease*, in the hope of giving more babies access to a full diagnosis. This could help ensure babies get the most appropriate care. 

What is the problem and who does it affect?

We can all get startled, it is a natural response to potential danger, but for some babies this natural response is problematic. “Babies with a rare illness called startle disease react in an excessive way when startled,” explains Professor Harvey. “Their bodies become stiff and they are unable to move for a brief period. This can be as brief as a few seconds or for many minutes. Sometimes they stop breathing, which is obviously terrifying for their parents, and the disease has been linked to sudden infant death.”

Things that prompt the startle reaction include sudden, unexpected noises, movements and touches, and unexpected sight of people or objects. If diagnosed correctly, babies can be treated with drugs that help reduce this unwanted startle and can also reduce muscle stiffness. Symptoms often fade by the time babies reach their first birthday, but they can continue throughout childhood and into adulthood.

“Genetic changes in at least three genes have been linked to startle disease. Diagnosis often involves genetic testing for changes in only one of those genes (GLRA1) which is thought to be the most common cause of the disease,” says Professor Harvey. “However, many babies with startle disease do not carry any of the known genetic changes – in fact, around three fifths of cases remain unexplained, which suggests there are some genes for startle disease that we have not discovered yet.1,2

“This problem is heartbreaking for parents,” adds Dr Thomas. “The natural reaction of a parent is to cuddle their child close when they have a startle attack, which just exacerbates the startle by stimulating the child more. Bonding moments like feeding and dressing become a trial – as parents do their best not to startle their baby.”

* Other names for startle disease include hyperekplexia, hyperexplexia and stiff-baby syndrome.

What is the project trying to achieve?

The team is searching for more of the genetic changes that cause startle disease, using DNA samples donated by around 40 people – sufferers of the disease, and their parents and siblings. “Identifying genetic causes of startle disease that have so far eluded discovery should lead to new genetic tests for babies and children worldwide,” says Professor Rees.

Understanding the genetic causes is vital to ensure that babies get the correct treatment, as Dr Thomas explains: “Certain genetic changes, for example, cause severe breathing problems during early infancy. Training these babies’ parents in resuscitation techniques and offering monitoring of heart rate and breathing could prove to be life-saving.”

“Children with startle disease sometimes have other problems too, such as learning difficulties. Knowing the genetic causes of each child’s illness enables us to predict more accurately what sort of educational needs they are likely to have in the future, which will help parents gain access to appropriate support services.”

What are the researchers’ credentials?

Project LeaderProfessor R J Harvey PhD
Project team
  • Dr R Thomas MRCP
  • Professor M I Rees PhD FRCPath
LocationDepartment of Pharmacology, UCL School of Pharmacy, London
Other locations
  • College of Medicine, Swansea University
DurationTwo years
Grant awarded16 November 2011
Start date1 March 2012
End date28 February 2014
Grant amount£124,835.00
Grant codeGN1966

We do not provide medical advice. If you would like more information about a condition or would like to talk to someone about your health, contact NHS Choices or speak to your GP. Please see our useful links page for some links to health information, organisations we are working with and other useful organisations. We hope you will find these useful. We are not responsible for the content of any of these sites.

This study is a joint effort between Professor Robert Harvey of the UCL School of Pharmacy, London and Professor Mark Rees and Dr Rhys Thomas at the Institute for Life Science, Swansea. These researchers have had a productive working relationship over the past ten years and have identified genetic causes of several childhood disorders, including startle disease.


  1. Harvey RJ, Topf M, Harvey K, Rees MI (2008) The genetics of hyperekplexia: more than startle! Trends in Genetics 24: 439-447.
  2. Thomas RH, Stephenson JBP, Harvey RJ, Rees MI (2010) Hyperekplexia: Stiffness, startle and syncope. Journal of Pediatric Neurology 8: 11-14.
Help us spread the word