Post-ictal
forceful yawning: an autonomic symptom in a
patient with nondominant hemisphere
epilepsy
Yankovsky A, Andermann F , Dubeau F
Montreal Neurological
Hospital and
Institute McGill University,
Canada.
Clinical Neurophysiology: EEG - Video
Monitoring.
Rationale: Yawning, an autonomic
phenomenon, has surprisingly rarely been
described in association with seizures and has
not previously been documented by
video-EEG.
Methods: We studied a 48-year-old
woman with a long history of non-dominant
centro-parietal seizures who developed forceful
repetitive post-ictal yawning.
Results: The patient began having
intractable epileptic attacks at age 18. She
described five types of seizures. At 30, she
underwent invasive EEG studies, which showed
epileptiform abnormalities over the right
parietal operculum. Brain CT and MRI were
normal. A right inferior parietal and posterior
temporal resection did not lead to improvement.
At 31, she had a second resection at the
temporal edge of the previous operation again
with no improvement. The tissue showed no
definite abnormality.
Yawning appeared late (approximately 24
years after onset of her seizures). It was
repetitive, irresistible and forceful starting
from 1 to 30 seconds after the seizure offset
and lasting from 5 to 60 seconds. During video
telemetry it was observed after most (86%) focal
sensory-motor seizures and after one third of
simple sensory attacks. She was alert during all
yawning episodes. A video will be
presented.
Conclusions: Yawning may be added to
the other autonomic peri-ictal symptoms such as
spitting, water drinking, vomiting, urinary
urgency or coughing. There is evidence
suggesting that such symptoms involve primarily
the nondominant hemisphere and this may be the
case for yawning as well.
