Abstracts

Is it Peri-ictal Cough or Cough-related Syncope?

Abstract number : 3.182
Submission category : 4. Clinical Epilepsy
Year : 2011
Submission ID : 15248
Source : www.aesnet.org
Presentation date : 12/2/2011 12:00:00 AM
Published date : Oct 4, 2011, 07:57 AM

Authors :
C. Livsey, L. Frey, M. Spitz

Rationale: Peri-ictal coughing has been associated with temporal and extratemporal onset epilepsy. Cough-syncope, first described as laryngeal vertigo by Charcot in 1876, is in the differential diagnosis of ictal cough and can cause confusion and misdiagnosis in some cases. Methods: We reviewed cases from the authors' clinics from 2007 to 2010 and identified 3 patients with peri-ictal coughing.Results: Patient #1 is a 63 year old male who was previously diagnosed with 'cough syncope' and 'post-syncopal convulsion'. An interictal EEG demonstrated left frontal sharps and spikes, and he had a witnessed event consistent with frontal lobe localization related epilepsy (LRE). His seizures begin with a coughing episode followed by stiffness, loss of consciousness and tonic-clonic activity for 1-2 minutes. Patient #2 is a 58 year-old male who experienced rare episodes of syncope with extreme physical exertion in his 20's. He had no events for decades until he experienced 6 events within one year in his late 50's, initially diagnosed as cough syncope. These consisted of an onset of coughing with a subjective sensation of confusion that was not presyncope. He would then lose consciousness followed by rhythmic diffuse motor activity. This was followed by postictal confusion for approximately one hour. He was treated with lamotrigine, and he did not have any further spells with 3 years of followup. Patient #3 is an 18 year old male with left temporal LRE, found to have chronic encephalomalacia and hemosiderin deposition in the left temporal lobe. He underwent Phase I and Phase II monitoring in the epilepsy monitoring unit before having resective surgery (cortectomy). Prior to surgery, he had multiple seizures, all similar in semiology containing some or all of the following: tapping of his left hand, calling out 'mom', bimanual automatisms, an odd facial expression, oral automatisms, with decreased responsiveness, followed by a post-ictal cough. Following surgery he is seizure-free.Conclusions: Peri-ictal cough is an uncommon manifestation of focal onset epilepsy that can lead to diagnostic confusion. Two of our three patients were initially diagnosed with cough-related syncope, delaying formal diagnosis and appropriate treatment for their seizures. The presence of cough in association with loss of consciousness should provoke an evaluation for both syncope and possible seizures.
Clinical Epilepsy