Cough syncope induced by post nasal drip successfully managed by Gabapentin

Abstract

Syncope is a common complaint in both neurology clinic and emergency department. It is defined as transient loss of consciousness with loss of postural tone, which is usually self-limited and followed by a spontaneous recovery. Our report describes a case of cough syncope resulting from chronic intractable cough caused by post nasal drip. Although his experience was debilitating, we were able to control his symptoms significantly using a small dose of Gabapentin. This dose is much lower when compared with the already established licensed indicated higher doses used for the treatment of neuropathic pain and epilepsy. Cough syncope is a demanding condition that results in comprehensive costly investigations. In addition, cough syncope could be misinterpreted as epilepsy by the treating team. Pulmonologists should be aware of the use of Gabapentin as the management of cough refractory to standard antitussive therapy. Further studies are needed to assess the effectiveness of low doses of Gabapentin in the management of chronic cough.

Comment on ‘Cough syncope as a cause of motor vehicle crash: fatal distraction?’

“…Regarding prevalence, we agree that cough syncope can be described as 'rare' 12 or 'uncommon', 8,13 but the literature also uses 'very rare', 9 'rare/infrequent', 14 'may not be uncommon', 15 'frequently overlooked' 14 and 'definitely not rare'. 3 Although cough syncope is a well-recognised disorder with several hundred cases reported in the literature, no study has looked at the rates, so significant uncertainty remains as to its frequency.…”

“…We make the following comments:Although the literature indicates that typical cough syncope patients are middle-aged, large-framed smokers with obstructive lung disease, 2 a range of predisposing conditions has been reported, including central nervous system disorders, cardiovascular disorders, whooping cough, 3 asthma, 4 eosinophilic lung disease, 5 cystic fibrosis, 6 influenza A 7 and post-nasal drip. 8 Regarding the proposed criteria for diagnosis of cough syncope, we do not understand the significance of 'immediately recognised'. By whom?…”