[Yawning and temporal lobe epilepsy]

Area of Science:

• Neurology
• Sleep Medicine
• Epileptology

Background:

• Temporal lobe epilepsy (TLE) is a common partial epileptic disorder characterized by recurrent seizures originating in the mesial temporal structures.
• Sleep abnormalities, particularly NREM sleep, can facilitate seizure propagation and are often provoked by epilepsy.
• The relationship between limbic epilepsy and yawning, a physiological reflex, is rarely reported.

Observation:

• Two patients with TLE presented with unusual yawning patterns related to their seizures.
• A 95-year-old male experienced yawning preceding a complex partial seizure during drowsiness, with EEG showing bilateral temporal sharp waves.
• A 17-year-old female exhibited yawning post-seizure (complex partial and secondarily generalized) after naps, with polysomnography revealing temporal spikes during NREM sleep.

Findings:

• Both patients responded well to antiepileptic medications (carbamazepine and divalproex sodium, respectively), with no recurrence of episodes.
• The study suggests shared neurochemical mechanisms and anatomic structures between TLE, sleep-wake cycles, and yawning.
• Yawning may represent an endogenous opioid-induced mechanism that helps prevent or stop TLE recurrence.

Implications:

• Yawning could serve as a potential biomarker or indicator for specific forms of temporal lobe epilepsy.
• Further research into the neurochemical pathways linking yawning and epilepsy may reveal novel therapeutic targets.
• Understanding the interplay between sleep, yawning, and TLE is crucial for comprehensive patient management and diagnosis.