PATHOLOGIC YAWNING IN NEUROMYELITIS OPTICA
SPECTRUM DISORDERS
Marco A. Lana-Peixoto1, Dagoberto Callegaro2, Natália C. Talim1, Lívia Talim1, Samira
2
1
A. Pereira , Gilberto Belisário Campos .
1CIEM
MS Research Center, Federal University of Minas Gerais Medical School, Belo Horizonte, and
2University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
Background
Brainstem, hypothalamic and cerebral symptoms may occur in
neuromyelitis optica spectrum disorders (NMOSD).However,
pathologic yawning has not been previously described in
NMOSD patients
Objective
V
The present study analyzes pathologic yawning in NMOSD
patients
V
Methods
Patients with NMOSD who complained of excessive yawning
spells initially drew our attention to this symptom. The diagnosis
of NMO was performed on the basis of the revised criteria of
Wingerchuk et al. (2006), and the term NMOSD was used as
defined by Wingerchuket al. (2007). Serum AQP4-IgG was
determined using cell-based assay (Takahashi et al., 2006).
Pathologic yawning was defined as a frequency higher than three
yawns/15 minute, or 28 yawns/day (Singer et al., 2007).
Conclusion
Results
Pathologic yawning may be a neglected although not a rare
Nine
symptom in NMOSD.
AQP4-IgG seropositive NMOSD patients experienced
excessive yawning not related to sleep deprivation or fatigue.
Patients were female, aged 19–57 years (median, 39 years) at
disease onset. Excessive yawning spells were the presenting
symptom of the disease in five patients, lasted 2–16 weeks, and
usually occurred in association with nausea, vomiting and
hiccups. Brain MRI was abnormal in all patients and most
frequently showed brainstem and hypothalamic lesions.
Acknowledgments
The authors thank Prof. Kazuo Fujihara and Dr. Douglas Sato for
help with the AQP4-IgG cell-based assays performed at Tohoku
University, Sendai, Japan.
Patient
Sex/Age at
onset (Yrs)
Race
NMOSD
Presenting
symptoms
1
2
F/19
F/39
W
M
TM
DNMO
TM
Y/N/V/BS/ON
Interval between
yawning spells and
ON/TM (months)
+9
0
Duration of yawning Other brainstem symptoms
spells (weeks)
3
4
5
F/45
F/40
F/46
M
M
W
DNMO
DNMO
DNMO
Y/N/V/H/BS/HT
Y/N/V/H
Y/N/V/H/BS/HT
-2
-32
-3
12
2
12
6
7
8
F/31
F/22
F/28
M
W
W
DNMO
DNMO
DNMO
BS
ON/TM
TM
+128
+60
+24
12
16
8
9
F/57
B
DNMO
Y/N/V/H
TM/BS/HT
0
2
4
2
Hypothalamic
symptoms
Hypotension, fever
Facial dysesthesia, facial
paralysis, hearing loss,
paralysis of upward gaze
Dysarthria, dysphagia Hypersomnia, cataplexy
Diplopia, nystagmus, facial
Hypersomnia,
dysesthesia, dizziness,
hypotension
dysarthria, dysphagia
Nystagmus
Hypersomnia
Hypersomnia
Diplopia, nystagmus,
ataxia
Dizziness, ataxia
Hypersomnia
W: white; M: mulattoe; B: black; NMOSD: neuromyelitis optica spectrum disorder; ON: optic neuritis; TM: transverse myelitis; DNMO: definite neuromyelitis optica; Y: yawning; N: nausea; V: vomiting; H: hiccups; BS: brainstem; HT:
hypothalamic