A 59-year-old man presented for care who, for 8 years, had had recurrent attacks of yawning and severe fatigue initiated by relatively mild exercise of his right leg (Figure). In 2011, he had a herniation of the L4-5 disc, which affected the right L4 root. Conservative treatment noticeably reduced the sciatic pain on the right side within a few months. However, after this event, he would promptly experience attacks of yawning and fatigue each time he engaged in moderate exercise of the right leg (eg, going upstairs, riding a bicycle, or repeatedly pushing certain weights only with his right leg). Attacks were not associated with a headache or body temperature change, and similar exercises of the other 3 limbs did not provoke yawning and fatigue. Neurological, endocrine, and cardiopulmonary investigations, including brain magnetic resonance imaging, echocardiography, polysomnography, and right-leg electrophysiology, yielded no crucial pathological findings. Video 1 shows an attack of yawning and fatigue symptoms while walking on a treadmill, immediately after an increase of the incline to 3%.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Dibaj P, Brockmann K, Gärtner J. Dopamine-Mediated Yawning-Fatigue Syndrome With Specific Recurrent Initiation and Responsiveness to Opioids. JAMA Neurol. 2020;77(2):254. doi:10.1001/jamaneurol.2019.3937
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: