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mise à jour du
23 septembre 2001
Lancet
1988, 1(8580), 300
cas chniques
Is yawning a brainstem phenomenon ?
Wimalaratana HS, Capildeo R
Regional Centre for Neurology and Neurosurgery, Oldchurch Hospital, Romford, Essex
a stroke patient who stretched his hemiplegic arm during yawning
Chat-logomini
Yawning occurs throughout the animal kingdom. Its purpose, physiological basis, and neuroanatomical pathways remain a mystery. There are few publications on yawning and only a brief account is to be found in most physiology textbooks. A yawn is a deep inspiratory movement with a wide-open mouth often accompanied by stretching of limbs. We describe a stroke patient who stretched his hemiplegic arm during yawning. Similar cases may help to postulate neuroanatornical pathways involved in yawning. [autres cas : Mulley , Blin : A single report of hemiplegic arm stretching related to yawning: further investigation using apomorphine administration ]

A 65-year-old man was admitted with acute onset of right-sided weakness. On examination he had a right upper motoneurone facial weakmess. The power in upper and lower limbs was 0/5 and 2/5, respectively. A computerised tomographic head scan showed an area of infarction in the left intemal capsule. His wife noted that he stretched both arms equally during yawning. A nurse saw similar movements on a subsequent occasion. The patient was also aware of this unusual movement of his arm but voluntary efforts to stretch the arm were unsuccessful, as were attempts to study power and tone of the limb during these involumary movements because he did not yawn in the presence of investigators. Limb movement during yawning faded away, apparently with the development of spasticity.

A case-report of a patient in whom "locked-in syndrome" developed after a pontine lesion commented that this patient could not open and close his mouth voluntarily but was able to do so when yawning (Gschwend).

These two cases demonstrate the involuntary nature of yawning. Our case indicates the non-involvement of pyramidal tracts in yawning, which appears to be operating from a point below the level of the pons, possibly in the medulla oblongata. Yawning is unassociated with other related physiological events and therefore must possess an indepenent medullary centre of its own which could be called a "yawning initiating centre YIC" Thus neuroanatomical patways involved in yawning should include non-pyramipal (or extrapyramidal) projections from YIC down to the brainstem nuclei and the anterior horn cells in the spinal cord, to share the common lower motoneurone pathway.

The infectious nature of yawning cannot be ignored. The probably indicates afferent patways to the YIC. Any further interpretation without more evidence of the complex process yawnig would be an over simplification.

Malcom Weller (Lancet, Vol 331 1988. Apr. 23: (8591): 950)

Dr Wimlaratana assert the purpose of yawning remains a mystery and Dr Forrester (mars 12p56) suggests that its purpose is to maintain lung compliance and inflate collapsed alveoli. I suggested third possibility . As Wimalaratana mention yawning is infectious. Animals would have a greater tendency to sleep together if the first to become weary was to signal and if the others were to respond. The infectious nature may therefore have a group cohesive function, which has survival implications for animals that hunt in packs or protect themselves in herds.

Dave Gilbert (The Lancet, 1988; Vol. 331 No. 8585 p 596)

Dr Wimalaratna and Dr Capildeo (Feb 6 p 300) discuss two cases which demonstrate the involuntary nature of yawning. In the rat, the stretch-yawn response bas been investigated pharmacologically and can be reliably induced with low doses of dopamine receptor direct agonists, such as apomorphine. Bouts of yawning, which occur during periods of hypomotility, are thought to follow stimulation of dopamine D2-autoreceptors in preference to postsynaptic dopamine D2-receptors, whose stimulation would result in hypermotility. The locus of dopamine receptor-mediated yawning has not been established.

Dopamine agonist-induced yawing is easily blocked with neuroleptics such as sulpiride, a dopamine D2-receptor antagonist widely used in the management of chronic schizophrenia. Studies where sulpiride is used to block apomorphine-induced yawning and hypomotility and related studies where dopamine autoreceptors have been blocked suggest that neuroleptic agents, especially at the low doses commonly used clinically, may cause increased stimulation of postsynaptic dopamine D2-receptors. This poses a serious question for the dopamine hypothesis of schizophrenia.

Thus, ironically, the stretch-yawn, which was described mystery by Wirnalaratna and Capildeo in its purpose, physiological basis, and neuroanatomical pathways, may prove a valuable tool for understanding how dopamine antagonists are effective in the treatment of schizophrenia.

 John M Forrester (Forrester, J.M. Is yawning a brainstem phenomenon? The Lancet 1988;331(8585):596.)

Wimalaratna and Capildeo suggest that yawning is organised by the medulla, but that its purpose remains a mystery, and that it is "unassociated with other related physiological events".

The link with the medulla was suggested as long ago as 1906 when Mosso stated: "Patients who suffer from cerebral anaemia or from certain affections of the medulla oblongata often yawn continually". What is the function of yawning ? Mead and Collier showed that lung compliance of anaesthetised dogs fell during about 2 h of spontaneous breathing to about 60% of its initial value, but could be restored rapidly by deep inflation of the lungs-most of it by a single deep inflation. These results were in accord with measurements in man and were later noted by anaesthetists.

There are two reasons for the loss of compliance. The surfactant film may get "old and weary" if not occasionally well stretched. Although this might add to the work involved in gentle breathing, in itselfit may be of little practical importance. Secondly, alveoli may collapse. Here besides the extra work, blood is shunted and arterial oxygenation is impaired. This surely matters. Yawning can prevent it, but so, of course can a sigh. In rats, yawning is associated with at least one other related physiological event, penile erection.

Comprendre avec l'aide de K Ezure la coordination respiration - marche
Convergence of central respiratory and locomotor rhythms onto single neurons of the lateral reticular nucleus Ezure K, Tanaka I Exp Brain Res1997; 113; 2; 230-242
 
Abercrombie J, Gendrin A Des maladies de l'encéphale et de la moelle épinière Germer-Baillière 1835
Abercrombie J Yawning and apoplexy Medical Times and Gazette 1863;1:656-661
Bauer G. et al Involuntary motor phenomena in the locked in syndrome J Neurology 1980;223;:91-198
Bertolotti M. Etude sur la pandiculation automatique des hémiplégiques Rev Neurol 1905;2(19): 953-959
Blin O, Rasol O, Azulay JP, Serratrice G. A single report of an hemiplegic arm stretching related to yawning J Neuro Sci 1994;126:225-227
Brissaud E, Pinard, A, Reclus P Pratique médico-chirurgicale Hémiplégie par A Souques Masson 1907, p538-539
Brissaud E Leçons sur les maladies nerveuses Masson 1895, p458
Darwin E. Zoonomia 1801
de Buck Classification des mouvements anormaux associés à l'hémiplégie Rev Neurol 1899;6:361-365
Furtado D. Provocation spinale d'un réflexe de bâillement. Rev d'oto neuro ophtalmologie.1951;23(1):
Ghika J., Bogousslavsky J. Dissociated preservation of automatic-voluntary jaw movements in a patient with biopercular and unilateral pontine infarcts Eur Neurol 2003;50:185-188
Heusner A P Yawning and associated phenomena Physiological Review 1946;25:156-168
Klippel M et Monier-Vinard R. Hémiplégie flaccide. Nouveau Traité de Médecine. Masson. 1928 p 316
Lanari A., Delbono O. The yawning and stretching sign in hemiplegics Medicina (B Aires) 1983;43(3):355-35
Liecey Nouvelle observation de bâillement convulsif périodique Le Courrier Médical 1879;29;334-336
Liégey Deux observations de bâillements intermittents Gazette médicale de Strasbourg 1851; p118-119
Louwerse E Forced yawning as a pseudobulbar sign in amyotrophic lateral sclerosis J Neuroscience Research 1998, sup, 392
Mulley G. Assoctiated reactions in the hemiplegic arm Scand J Rehab Med 1982;14:117-120
Ogle JW. Arm rising during yawning The Medical Times and Gazette. 28 february 1863 p 213
Pierre Marie La Pratique Neurologique Hémiplégie, mouvements associés Masson 1911, p477-480
Pierre Marie et Léri A. Mouvements involontaires dans les membres paralysés 1911 Nouveau Traité de médecine et de thérapeutique Brouardel, Gilbert, Thoinot JB Baillière Ed 1911 p283-291
Purves-Stewart J. Le diagnostic des maladies nerveuses 1939
Quoirin E. Elévation involontaire du membre supérieur chez l'hémiplégique lors d'un bâillement Thèse doctorat en médecine Poitiers 2002
Thomson HC Associated movements in hemiplegia : their origin and physiological significance Brain 1903;26:515-523
Töpper R, Mull M, Nacimento W Involuntary stretching during yawning in patients with pyramidal tract lesions: further evidence for the existence of an independent emotional motor system European J Neurology 2003;10:495-499
Trautmann R. Le bâillement Thèse Bordeaux; 1901-02; N° 40; 86 pages
Vulpian A Leçons sur la physiologie générale et comparée du système nerveux faites au Museum d'histoire naturelle. Rédigées par E.Brémond. Paris, Baillière, 1866
Vulpian A Maladies du système nerveux Paris, Doin, 1879
Walshe FMR  On certain tonic or postural reflexes in hemiplegia with special reference to the so called "associated movements".   Brain, 1923;46:1-37
Wimalaratna HS, Capildeo R. Is yawning a brainstem phenomenon ? a stroke patient who stretched his hemiplegic arm during yawning Lancet 1988;1(8580):300