Why do als patients yawn

They found that this dopamine agonist induced blinking and yawning in all their participants. Another interesting finding is the occurrence of yawning in the withdrawal syndrome after prolonged use of opioids or coffee 11 In , Sommet et al. Drug-induced yawning: a review of the French pharmacovigilance database.

Drug Saf. They found 28 reports involving 38 drugs, especially serotonergic agents, dopaminergic agents, opioids, and benzodiazepines 26 Yawning has been observed secondary to acute hemorrhagic or ischemic anterior or posterior circulation stroke 27 Yawning as a clinical sign of ischemic stroke. Rev Neurol.

Abnormal yawning in stroke patients: the role of brain thermoregulation. Front Neurosci. Pathological yawning as a presenting symptom of brain stem ischaemia in two patients. Yawning despite trismus in a patient with locked-in syndrome caused by a thrombosed megadolichobasilar artery. Clin Neurol Neurosurg. In general, it indicates damage to the brainstem reticular formation and cortical and subcortical structures 27 In , Cattaneo et al. Yawning has been described in patients with locked-in syndrome due to vertebrobasilar stroke caused by a thrombosed megadolichobasilar artery 30 Another potential cause of yawning in patients with stroke is intracranial hypertension or even herniation 27 More recently, Krestel et al.

They found a correlation between ischemic lesions in the insula and caudate nucleus and a period of abnormal yawning and suggested that the insula may be the main region of the brain responsible for serotonin-mediated yawning 23 A rare and very interesting clinical condition involving yawning known as parakinesia brachialis oscitans is related to stroke and will be described below.

Occasionally, in patients with acute hemiplegia, the onset of yawning is associated with an involuntary raising of the paralyzed arm 31 Hand up! Yawn and raise your arm. Int J Stroke. This phenomenon was named parakinesia brachialis oscitans in by Walusinski et al. In their seminal paper, Walusinski et al. They suggested that resection of the cortico-neocerebellar tract of the extrapyramidal system disinhibits the spino-archeocerebellar tract, enabling motor stimulation of the arm by the lateral reticular nucleus, which has a link with respiratory and locomotor rhythms.

Several case reports have since been published describing this phenomenon, including others by Walusinski et al. Parakinesia brachialis oscitans: report of three cases. Parkinsonism Relat Disord. A case of parakinesia brachialis oscitans. Associated movements in hemiplegic limbs during yawning. Kang P, Dhand A. Teaching Video NeuroImages: movement of a paralyzed arm with yawning. Mov Disord Clin Pract Hoboken.

In , Zorzetto et al. Parakinesia brachialis oscitans during thrombolytic therapy. BMJ Case Rep. In , Kang and Dhand 36 After yawning, paralysis always resumed.

In a recent publication, Alves et al. Voluntary control of a plegic limb during yawning. J Neurol. Figure 3 Parakinesia brachialis oscitans in a patient with right hemiplegia due to ischemic stroke. In general, yawning is used as an indicator of activity of the dopamine-oxytocin pathway 13 Chen JJ, Obering C.

Clin Ther. Yawning was described by von Economo in patients with acute encephalitis lethargica or postencephalitic parkinsonism 8 8. Curiously, Sandyk et al. Sandyk R. Excessive yawning and progressive supranuclear palsy. Int J Neurosci.

In , Giganti et al. Yawning: a behavioural marker of sleepiness in de novo PD patients. They showed that the circadian distribution of yawning was not altered in untreated patients with early-stage PD and concluded that yawning is a behavioral marker of sleepiness in de novo PD patients 42 Yawning can occur in different epileptic syndromes 11 Video case report post-ictal forceful yawning in a patient with nondominant hemisphere epilepsy.

Med Hypotheses. Peri-ictal yawning lateralizes the seizure onset zone to the nondominant hemisphere in patients with temporal lobe epilepsy.

Epilepsy Behav. Controllable yawning expressed as focal seizures of frontal lobe epilepsy. Epilepsy Behav Case Rep. Pathological yawning as an ictal seizure manifestation in the elderly. It has been described in the peri-ictal period in children with infantile spasms and in patients with temporal lobe epilepsy peri-ictal yawning preceding complex partial seizures or yawning in the post-ictal period 43 In , Specchio et al.

Kuba et al. They observed peri-ictal yawning in 4. They also observed that peri-ictal yawning occurred only in patients with right-sided, nondominant temporal lobe epilepsy, suggesting that it may have a lateralizing value. Wasade et al. In , Nicotra et al. Some patients with intracranial hypertension, brain swelling or herniation due to stroke, head trauma or brain tumors may present with yawning together with headache and seizures 11 In , Saura et al.

Intractable yawning associated with mature teratoma of the supramedial cerebellum. J Neurosurg. Yawning may also occur as a presenting symptom of Chiari malformation type 1 50 Yawning as a presenting symptom of Chiari malformation Type I: report of 2 cases. J Neurosurg Pediatr. Migraine represents a very common neurological problem, and the pathophysiology of migraine attacks has been shown to be related to dopaminergic transmission 51 Peroutka SJ.

Dopamine and migraine. Akerman S, Goadsby PJ. Dopamine and migraine: biology and clinical implications. In the premonitory phase, yawning can be present in association with malaise, somnolence and mood changes among other manifestations 51 Some migraineurs may experience excessive yawning during the visual aura before the attack 51 However, excessive yawning in migraine can be improved with dopamine receptor antagonists, which are effective therapeutic agents for this condition 51 Some patients with multiple sclerosis MS present with thermoregulatory dysfunction 53 Pathological yawning as a symptom of multiple sclerosis.

Therefore, sleep problems and yawning could be symptoms of MS 11 Gallup et al. Yawning, sleep, and symptom relief in patients with multiple sclerosis. Sleep Med. In , Postert et al. Pathologic yawning in neuromyelitis optica spectrum disorders. Mult Scler Relat Disord.

They concluded that yawning may be a neglected symptom in neuromyelitis optica spectrum disorder 55 Yawning can be observed in patients with amyotrophic lateral sclerosis ALS 11 Williams 56 Williams DR.

The yawning reflex: an upper motor neuron sign in amyotrophic lateral sclerosis. During the follow-up, the patient developed bulbar palsy, and an electromyogram confirmed the diagnosis of amyotrophic lateral sclerosis 56 In , Wicks 57 Wicks P. Excessive yawning is common in the bulbar-onset form of ALS. Acta Psychiatr Scand. Contagious yawning can be explained by the relationship between yawning and social empathy 2 2.

Interestingly, in some psychiatric disorders, such as autism and schizophrenia, yawning is very rare 11 Absence of contagious yawning in children with autism spectrum disorder. Biol Lett. Empathy in schizophrenia: impaired resonance. Eur Arch Psychiatry Clin Neurosci. In , Senju et al. They concluded that contagious yawning is impaired in autism spectrum disorder, supporting the idea that contagious yawning is based on the capacity for empathy 58 They observed that schizophrenic patients showed a significantly lower rate of yawning, suggesting that susceptibility to contagious yawning is reduced in patients with impaired social empathy 59 Yawning can sometimes cause complications, such as mandibular subluxation, painful cramps in the geniohyoid muscle and fracture of the styloid apophysis 11 More rarely, it can trigger an attack of glossopharyngeal neuralgia, idiopathic carotidynia or even Marin Amat syndrome, a form of acquired facial synkinesis manifesting as involuntary eyelid closure on jaw opening that often occurs following the aberrant regeneration of the facial nerve after a peripheral facial palsy 11 Malhotra A.

Marin-Amat syndrome: a case of acquired facial synkinesis. In contrast, yawning can improve Eustachian tube dysfunction and dysbaric facial paralysis and even acts as a therapy for vocal fatigue 11 Gallup and Gallup 5 5. Yawning is a stereotyped physiological behavior that can be a sign or symptom of several neurological conditions, such as stroke including stroke with parakinesia brachialis oscitans , parkinsonism and epilepsy. More rarely, yawning can occur in patients with intracranial hypertension, multiple sclerosis, migraine and amyotrophic lateral sclerosis and can be induced by drugs.

It is rare in patients with autism spectrum disorders or schizophrenia 11 As ALS progresses, swallowing may become more difficult, this is known as dysphagia and is sometimes misdiagnosed as a throat blockage. In very rare cases, ALS amyotrophic lateral sclerosis can begin by first affecting the thorax chest in the initial phases of the condition as opposed to affecting them towards the final stages of the disease.

This is known as respiratory-onset disease. In some cases, the initial symptoms are more obvious, such as a shortness of breath or battling to breathe. In a number of other cases, the symptoms can be less obvious and include the patient waking up on a constant basis during the night due to their brain being temporarily deprived of oxygen when they lie down.

This often results in the individual feeling extremely tired and being left with a painful headache due to oxygen deprivation. As ALS progresses, the differences between the types of the condition become less noticeable due to increasing functions and areas of the body being affected.

The rate that the disease spreads will vary, however, it will often remain at a similar pace for the individual, meaning once the person has been diagnosed, it is unlikely that the condition will speed up or slow down. Because of this, the patient may find movement of his or her limbs more and more difficult.

The muscles can also stiffen, which is a condition known as spasticity. Both the wasting of muscles and stiffness may also result in joint pain.

Bear in mind that while episodes of choking are often distressing, they are unlikely going to be the cause of death. Issues with swallowing result in a reduction of the action and in turn excess saliva can lead to drooling. Thicker saliva can make it difficult for the patient to clear their chest due to the muscles that control coughing being weakened. In some cases of ALS, the patient may suffer from episodes of uncontrollable and excessive yawning, regardless of whether they are tired or not.

This can sometimes result in a painful or even a dislocated jaw. This yawning is a reflex of the nerves deteriorating in the jaw area as they begin to malfunction. ALS can result in a number of emotional changes in an individual and can impact their ability to have control over their emotions, specifically when the muscles controlling speech and swallowing are weakened.

Particularly common signs in someone with ALS are episodes of uncontrollable crying, and more rarely, uncontrollable laughter. This is sometimes referred to emotionality, the pseudobulbar affect or emotional lability. The patient may often act out irrationally or feel unnecessarily sad or depressed.

In some cases, those with ALS may suffer from issues with their planning, concentration or language use. These are known as cognitive changes. This is an uncommon kind of dementia that significantly affects the sides and front of the brain, known as the temporal and frontal lobes, and results in issues with language and behaviour. These initial changes in ALS patients are often subtle, making it difficult to differentiate them from the normal process of ageing.

The patient is not always aware that they have problems affecting their personality and behaviour. In those with ALS, the muscles and nerves responsible for controlling the lungs will deteriorate progressively, this makes it difficult for the person to breathe properly. This often leaves the patient out of breath when performing everyday tasks such as taking out the trash or even going for a short walk. In time, the person may even suffer from a shortness of breath when they are resting.