Dopamine-Mediated Yawning and Fatigue Attacks

A 59-year-old man developed recurrent attacks of yawning, fatigue, and sleepiness triggered by exercise of the right leg after an L4-5 disc herniation 8 years prior. This video illustrates a provocation test as a step toward determining a mechanism of effect: dopamine elicits yawning, and subcutaneous injection of a 2-mg dose of apomorphine, a nonselective dopamine agonist, reproduced the patient’s exercise-induced symptoms. Click the article link for full clinical details and discussion and the video links for illustration of his exercise-induced attacks and the patient’s response to treatment.