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Images in Neurology
December 2, 2019

Dopamine-Mediated Yawning-Fatigue Syndrome With Specific Recurrent Initiation and Responsiveness to Opioids

Author Affiliations
  • 1Center for Rare Diseases Göttingen, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
  • 2Max-Planck-Institute for Experimental Medicine, Göttingen, Germany
  • 3Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
  • 4Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
JAMA Neurol. Published online December 2, 2019. doi:https://doi.org/10.1001/jamaneurol.2019.3937

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%.

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