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EN
Introduction. Coughing may be observed as an epiphenomenon during or after epileptic seizures. Aim. In this paper we discuss the lateralization and localization value of cough as an epileptic peri/post ictal semiological phenomenon. Material and Methods. Seven patients presenting cough as a part of their symptomatology are presented. We will discuss cough in the context of these seven patients. Results. Six out of these seven patients were multidrug resistant temporal lobe epilepsy patients, all were right handed. They were all examined for possible epilepsy surgery and four underwent surgery with complete seizure freedom. We do not have certain evidence for lateralization in one patient with hot water epilepsy though déjà vu as an initial symptom in this patient implies a temporal lobe onset. The seven other patients had temporal lobe epilepsy. Among the patients who had surgery, three had left sided and one had right sided temporal lobe surgery with consequent seizure freedom. Conclusion. Referring to the argument in the literature, with our small patient sample, we might conclude that cough has significant value in localizing seizures to the temporal lobe but overall these limited data do not suggest a lateralizing value.
EN
Cough is the most common symptom of the upper and lower airway diseases. In its nature, cough is a defence re-flex mechanism of the respiratory tract that is used to clear the upper and lower airways. Chronic cough, defined as cough lasting for more than 8 weeks, is reported in 3–40% of the general population and has an important impact on patients’ quality of life, by causing anxiety, physical discomfort, social isolation and personal emabarrassment, be-ing an often medical complaint and one of the most common reasons for outpatient visits. Upper airway cough syn-drome, asthma, eosinophilic bronchitis and gastroesophageal reflux diseases account for most chronic cough after excluding somking, angiotensin-converting enzyme inhibitor use and chronic bronchitis. Many patients have more than one reason for chronic cough. Some complex diagnostic procedures, in many individuals are necessary to rec-ognized the cause/causes of chronic cough and to establish the accurate diagnosis, which implies a higher chance of effective treatment. Despite detailed diagnostic procedures, in many cases, the efficacy of chronic cough treatment is questionable and ambiguous. We observe not always satisfactory response to therapy. There are some coughs that seem refractory despite an extensive work-up. The possibility of hypersenitive cough reflex response, defining pa-tients with Cough Hypersensitivity Syndrome has been proposed to explain these cases, rather resistant to cough treatment, previously known as idioapthic cough or refractory, unexplained cough. The concept of Cough Hypersen-sitivity Syndrome helps us to understand the mechanisms underlying cough and provides better therapeutic options to treat chronic cough, like neuromodulating drugs, and speech therapy.
EN
Coughing is a physiological defence mechanism against irritants that stimulate respiratory mucosa. On the other hand, it can be the first symptom of a disease. Depending on symptoms duration we distinguish acute cough, subacute and chronic cough. Cough can be paroxysmal, characteristic to asthma and pertussis or “barking” with inspiratory dyspnea occurring in croup (laryngitis subglottica); it can be also dry or productive. A particular type of cough is a postinfectious cough resulting from damage of respiratory mucosa, increased sensitivity of cough receptor and bronchial hyperresponsiveness. There is also psychogenic cough, cough accompanying allergic diseases and provoked by some drugs. Diagnosis of chronic cough include a detailed clinical history, physical examination and additional diagnostic tests. Among infectious agents, that predispose to long‑term cough, there are viruses, particularly human respiratory syncytial virus (RSV), atypical organisms – Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, najand bacteria, especially Bordetella pertussis. Apart from infectious diseases, the analysis of causes of cough in young children include the presence of gastroesophageal reflux, allergic diseases (especially asthma), chronic sinusitis, aspiration of foreign material, congenital structural abnormalities of the respiratory system and chronic respiratory diseases, including cystic fibrosis or primary ciliary dyskineswia. A cardiac causes of cough should also be considered. Often cough characteristics and accompanying symptoms may indicate its cause. In the treatment of cough we can use casual treatment and symptomatic medications among which there are antitussives and mucoactive drugs. It is permissible to use butamirate and levodropropizine in persistent dry cough. Administration of opioid agonists and preparations containing promethazine should be avoided. Mucoactive drugs include expectorants, mucolytic, mucoregulatory and mucoregulatory medications.
PL
Kaszel jest fizjologicznym odruchem obronnym organizmu, skierowanym przeciw czynnikom drażniącym błonę śluzową dróg oddechowych. Może być także pierwszym objawem choroby. W zależności od długości utrzymywania się objawów wyróżniamy kaszel ostry, przedłużający się oraz przewlekły. Kaszel może być napadowy, charakterystyczny dla astmy czy krztuśca, lub szczekający, z typową dusznością wdechową występującą w podgłośniowym zapaleniu krtani, suchy lub wilgotny. Szczególnym jego rodzajem jest kaszel poinfekcyjny, związany z uszkodzeniem nabłonka oddechowego, nasileniem wrażliwości receptorów kaszlowych i wtórną nadreaktywnością oskrzeli. Ponadto wyróżniamy kaszel psychogenny, polekowy oraz alergiczny. Diagnostyka przewlekłego kaszlu obejmuje szczegółowy wywiad kliniczny, badanie przedmiotowe oraz dodatkowe badania diagnostyczne. Do czynników zakaźnych, które predysponują do długo utrzymującego się kaszlu, należą wirusy, szczególnie często wirus RS, drobnoustroje atypowe: Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, a także bakterie, przede wszystkim pałeczka krztuśca. Oprócz schorzeń infekcyjnych w analizie przyczyn kaszlu u małych dzieci należy uwzględnić obecność refluksu żołądkowo‑przełykowego, choroby alergiczne (przede wszystkim astmę), przewlekłe zapalenie zatok obocznych nosa, aspirację ciała obcego, a także wrodzone wady i przewlekłe choroby układu oddechowego, w tym mukowiscydozę czy zaburzenia ruchomości rzęsek. Diagnostyka przewlekłego kaszlu powinna obejmować również przyczyny kardiologiczne. Niejednokrotnie charakter kaszlu i objawy towarzyszące wskazują na jego przyczynę. W leczeniu kaszlu stosujemy leki przyczynowe oraz leki działające objawowo, do których zaliczamy leki przeciwkaszlowe i sekretolityczne/mukolityczne. Spośród leków przeciwkaszlowych w uporczywym suchym kaszlu dopuszcza się stosowanie butamiratu lub lewodropropizyny. Należy unikać podawania agonistów receptorów opioidowych i preparatów zawierających prometazynę. Spośród leków sekretolitycznych zastosowanie znajdują leki wykrztuśne, mukolityczne, mukokinetyczne oraz mukoregulujące.
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