Salomon Muchnik, Samuel Finkielman, Gullermo
Semeniuk,
Maria Inès de Aguirre
Instituto de Investigaciones
Médicas Alfredo Lanari, Facultad de
Medicina, Universidad de Buenos Aires, Servicio
de Neurologia I.D.I.M Alfredo Lanari
Yawning
and temporal tobe
epilepsy
Abstract:
Temporal lobe epilepsy is a partial
epileptic disorder in which mesial structures
are responsible for the principal ictal
symptoms. Its chacteristic feature is the
recurrence of simple and complex partial
seizures, associated with postictal confusion
and anmesia of the event.
The facilitating effect of NREM sleep on the
propagation of the seizure, as well as the
sleep, abnormalities provoked by epilepsy were
evident in our two patients. Yawning is a
physiological reflex induced by arousal and
drowsiness and may appear in different
neurological conditions. Its relation with
epilepsy of limbic origin has been rarely
reported.
We describe in one ninety five year old male
patient, the occurrence of yawning followed by
complex partial seizure during a state of
drowsiness. His EEG showed independent bilateral
interictal loci of temporal sharp waves and
after being medicated with carbamazepine
400mg/day, the episode did not recur. Another
patient a seventeen year old female, displayed
complex partial seizures and secondarily
generalized seizures with yawnig during the
posictal period, after naps. The EEG was normal
and her polysomnography showed bilateral
synchronous temporal spikes and slow waves with
secondanly generalization during stage 2 of NREM
sleep that produce paroxysmal microarousals and
increased stages 1 and 2 of NREM sleep and REM
sleep diminished. After being medicated with
divalproex sodium 750 mg/day, she suffered no
futher seizures.
Temporal lobe epilepsy, sleep wake cycles
and yawning seem not only to share the same
anatomic structures but also the same
neurochemical mechanisms. The fact that
endogenous opiods are considered as part of a
protective system that stop and prevent seizures
may allow us to, postulate that yawning would be
the expression of the endogenous opiods induced
mechanisms, that stop and prevent the recurrence
of the temporal lobe epilepsy. Another view may
this is just a particular form of temporal lobe
epilepsy.
Specchio
N, Carotenuto A et al. Ictal yawning in a
patient with drug-resistant focal epilepsy:
Video/EEG documentation and review of literature
reports.Epilepsy Behav
2011
