Abstracts

Yawning, an autonomic phenomenon, has surprisingly rarely been described in association with seizures and has not previously been documented by video-EEG. We studied a 48-year-old woman with a long history of non-dominant centro-parietal seizures who developed forceful repetitive post-ictal yawning. 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. 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.