mystery of yawning
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
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mise à jour du
29 janvier 2018
Journal of Neurology
2018;265(2):433-435
Scholarpedia
Voluntary control of a plegic limb during yawning
 
Pedro Nascimento Alves, Mamede de Carvalho, Sofia Reimão, José Castro, Ana Catarina Fonseca, Patricia Canhão
 
Department of Neurosciences and Mental Health, Neurology, Stroke Unit
Hospital de Santa Maria, Lisbon, Portugal

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Tous les articles sur la parakinésie brachiale oscitante 
All articles about parakinsia brachialis oscitans
 
 
Yawning is a phylogenetically ancient phenomenon coordinated by a network of supratentorial and infratentorial centres located in brainstem, hypothalamus, and limbic regions [1]. Movements of plegic limbs during yawning in patients with stroke are common [2]. The first descriptions come from the 18th and 19th centuries by Darwin and by Abercrombie, respectively [3, 4]. These movements have always been described as involuntary and stereotyped, however [5]. We report a novel phenomenon: a stroke patient who could voluntarily control the movements of his plegic limb during yawning.
 
A 59-year-old right-handed male was admitted in the emergency department presenting right facial palsy, dysarthria, right hemiplegia, and right pain anesthesia of sudden onset. The relevant medical antecedents were diabetes mellitus and arterial hypertension. The presentation suggested a sensorimotor lacunar syndrome due to a subcortical stroke. The diagnosis of acute left Middle Cerebral Artery infarct was made and he was submitted to endovenous thrombolysis. The inferior limb deficit improved; however, the right superior limb remained plegic&emdash;grade 0 (MRC scale) in all segments, including abduction/adduction, flexion/extension, and medial/lateral rotation of the shoulder and flexion/extension and supination/pronation of the elbow. The only exception was the elevation of the shoulder, in which the patient could perform a full range of motion if the force gravity was eliminated (grade 2).
 
Since the first hours of stroke onset, the patient presented a reflexive, stereotyped movement of flexion of the right elbow while yawing. Remarkably, at day 6, the patient started to have voluntary control over that movement. Ability to touch the chin or the left arm with the right hand according to the request of the observer was documented (Online Resource 1). The patient noticed an association between the duration of yawning and the range of movements that he was able to do, such that during more sustained yawning, he could even perform more complex movements of distal joints&emdash;grabbing objects purposely, for instance. These movements could also be volitionally suppressed. They were impossible without yawning or when he simulated yawning. He did not notice an increase in the frequency of yawning, fatigue of the movement during multiple episodes of yawning, and his limb was not spastic.
 
MRI showed an infarct involving lenticular nucleus, anterior and posterior limbs of internal capsule, body of caudate nucleus, and corona radiata (Fig. 1a).
 
Tractography and transcranial magnetic stimulation confirmed the disruption on the left pyramidal tract (Fig. 2).
 
The topography of his lesion was compared to controls. The controls were selected prospectively and had: (a) an acute ischemic lesion on brain MRI of the left lenticulocapsulo-radiate region; (b) an upper limb paresis 2; (c) yawned during admission. Of the four controls selected, two did not present any movement during yawning and two presented involuntary movements exclusively.
 
Brain images were normalized to MNI152 space. The volume of lesion of the case was 8461 mm3 and that of the controls ranged from 3747 to 9858 mm3. The overlay of lesions of case and controls showed that some areas of the anterior limb of internal capsule, and of the anterior, posterior, and inferior regions of putamen were infarcted only in the described case, while some areas of the posterior limb of the internal capsule were lesioned in all controls but not in the case (Fig. 1b). The results were similar when controlling for patients with involuntary movements exclusively.
 
Disconnectome maps were created using BCB toolkit [6, 7]. Subtraction of the sum of disconnectome maps of controls from the disconnectome map of the case revealed two main areas of disconnection only present in the case: (a) gyrus rectus and middle orbitofrontal gyrus; (b) lateral orbitofrontal gyrus and frontal inferior gyrus pars triangularis (Fig. 1c). Controlling only for patients with exclusively involuntary movements revealed an additional cluster of disconnection in the temporal lobe.
 
We speculate that increased brainstem monoaminergic activation associated with yawn can permit movements, otherwise absent due to the corticospinal tract lesion. The putative change in the function of putamen as an element of basal ganglia motor circuits secondary to the lesion or to the disconnection to the ventromedial prefrontal cortex, and the disconnection to inhibitory areas, such as ventrolateral prefrontal cortex, observed in the described case, can be responsible for the volitional control [8, 9]. We believe that this first description can contribute to the identification of other similar cases. Although the use of dopaminergic medications has not been effective in motor rehabilitation after stroke, their specific use in similar cases might be promising [10]. Further studies with possible new cases and controlling for a higher number of patients with exclusively involuntary movements during yawning can contribute to a better understanding of the underlying physiopathology of this paradoxical phenomenon.
 
References
 
1. Krestel H, Bassetti CL, Walusinski O (2018) Yawning, its anatomy, chemistry, role, and pathological considerations. Prog Neurobiol.
2. Meenakshisundaram R, Thirumalaikolundusubramanian P, Walusinski O, Sweni S (2010) Associated movements in hemiplegic limbs during yawning. Front Neurol Neurosci 28:134&endash;139
3. Darwin E (1794) Zoonomia or the laws of organic life. J Johnson Ed, London
4. Abercrombie J, Gendrin A (1835) Des maladies de l'encéphale et de la moelle épinière. Germer-Baillière Ed, Paris
5. Walusinski O, Neau J, Bogousslavsky J. Hand up! Yawn and raise your arm. Int J Stroke 2010;5(l):21-7.
6. Thiebaut De Schotten M, Dell'Acqua F, Ratiu P et al (2015) From Phineas Gage and monsieur Leborgne to H.M.: revisiting disconnection syndromes. Cereb Cortex 25:4812&endash;4827
7. Foulon C, Cerliani L, Kinkingnehun S et al (2017) Advanced lesion symptom mapping analyses and implementation as BCBtoolkit. bioRxiv.
8. Leung H-C, Cai W (2007) Common and differential ventrolateral prefrontal activity during inhibition of hand and eye movements. J Neurosci 27:9893&endash;9900
9. Leisman G, Braun-Benjamin O, Melillo R (2014) Cognitive-motor interactions of the basal ganglia in development. Front Syst Neurosci 8:1-18
10. Ford G, Bhakta B, Cozens A et al (2015) DARS (dopamine augmented rehabilitation in stroke): longer-term results for a randomised controlled trial of Co-careldopa in addition to routine occupational and physical therapy after stroke. Abstracts of the UK Stroke Forum 2015. Int J Stroke 10(Suppl. 5):6
 
Le bras droit paralysé amène volontairement la main sur l'épaule gauche pendant le bâillement
Les auteurs rapporte un nouveau cas de parakinéise brachiale oscitante avec une particularité notable, la capacité acquise par le malade de mobiliser son bras paralysé au cours d'un bâillement, vers un but volontairement choisi.
 
Ce malade de 59 ans, diabètique et hypertendu, se présente aux urgenecs atteint d'une hémiplégie droite avec paralysie faciale centrale et dysarthrie, et insensiblilité de l'hémicorps lors de l'installation du trouble. L'imagerie cérébrale confirme un infactus sous cortical secondaire à une occlusion de l'artère cérébrale moyenne, pour laquelle il a reçu un traitement thrombolytique.
 
Secondairement la paralysie du membre inférieur a régressé mais pas celle du bras qui demeure totalement paralysé. Depuis les premières heures de l'attaque, le patient a remarqué que son bras effectuait un mouvement stéréotypé lors de chaque bâillement, à type de flexion du coude et élévation de la main vers la bouche. D'une manière originale, le patient s'est aperçu au sixième jour de sa maladie que, par sa volonté, il pouvait modifier la trajectoire du mouvement du bras paralysé (voir la vidéo) lui permettant de toucher soit son menton, soit l'épaule gauche avec sa main droite et ce, à la demande explicite de son médecin.
 
L'IRM et la tractographie ont montré une interruption de la voie pyramidale
 
References
 
[1] Walusinski O, Quoirin E, Neau J. Parakinesia brachialis oscitans. Rev Neurol (Paris) 2005;161(2):193-200.
 
[21 Walusinski O, Neau J, Bogousslavsky J. Hand up! Yawn and raise your arm. Int J Stroke 2010;5(l):21-7.
 
[3] Blin O, Rascol O, AzulayJ, Serratrice G, Nieoullon A. A single report of hemiplegic arm stretching related to yawning: further investigation using apomorphine administration. J Neurol Sci 1994;126(2):225-7.
 
[41 Topper R, Mull M, Nacimiento W. Involuntary stretching during yawning in patients with pyramidal tract lesions: further evidence for the existence of an independent emotional motor system. Eur J Neurol 2003;10(5): 495-9.
 
 
 https://link.springer.com/article/10.1007%2Fs00415-017-8729-z
 
https://doi.org/10.1007/s00415-017-8729-z