Author reply to comment by Brook et al on ‘Cough syncope as a cause of motor vehicle crash: fatal distraction?’

Abstract

Brook et al on 'Cough syncope as a cause of motor vehicle crash: fatal distraction?'We would like to thank Brook, Burton and Trembath 1 for taking the time to read and comment on our paper 2 related to our proposed criteria for cough syncope. They acknowledge that: (i) cough syncope is rare, (ii) other causes of altered consciousness should be sought, (iii) there is no confirmatory cough syncope test and (iv) a sleep disorder is a possible alternative diagnosis when related to motor vehicle crashes. Moreover, they do not dispute our interpretation of the pathophysiology of cough syncope, which underpins our criteria. Their main criticism of the suggested criteria for diagnosis is the 'reproducibility' of cough syncope. Our comment is based on the original descriptions of multiple episodes of cough syncope. 3,4 We also agree that expert witnesses must always abide within their field of knowledge and be truthful and unbiased, given their duty is to the court of law.