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Pathological yawning as an ictal seizure manifestation in the elderly

Alessia Nicotra1, Nofal M Khalil, P Owbridge

  • 1Department of Clinical Neurophysiology, Imperial College Healthcare NHS Trust, London, UK. a.nicotra@imperial.ac.uk

BMJ Case Reports
|October 19, 2012
PubMed

Insights

Excessive yawning can signal seizures, particularly in elderly individuals with consciousness impairment. This case suggests paroxysmal yawning may represent an autonomic seizure originating in the brainstem.

Area of Science:

  • Neurology
  • Epileptology
  • Autonomic Nervous System

Background:

  • Excessive yawning is a known peri-ictal phenomenon associated with seizures.
  • The diagnostic and prognostic significance of yawning in epilepsy requires further elucidation.

Observation:

  • A case of an elderly male patient presented with impaired consciousness and paroxysmal excessive yawning.
  • The yawning episodes occurred without other typical seizure manifestations.

Findings:

  • The authors hypothesize that paroxysmal excessive yawning can be considered an autonomic seizure.
  • This seizure type may originate from diencephalic or brainstem structures.
  • Yawning served as the primary ictal phenomenon in this case.

Implications:

  • This case expands the spectrum of ictal phenomena in epilepsy.
  • It highlights the importance of considering autonomic seizures in patients with unexplained paroxysmal excessive yawning.
  • Further research into diencephalic and brainstem seizure origins is warranted.

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