Bettolepsy. Literature review

Bettolepsy is an episode of loss of consciousness during a coughing attack. Bettolepsy is a rare syndrome. Among patients with pulmonary diseases, the prevalence is about 18%, in the general population - about 0.6%. The following options are being considered: loss of consciousness without convulsions, loss of consciousness with convulsions and occasionally pelvic disorders; fainting followed by confusion; seizures followed by “non-coughing” epileptic seizures; seizures in people who previously suffered from epilepsy; coughing syncope in people with organic brain lesions, venous encephalopathy. As a result of a sharp increase in intrathoracic and intra-abdominal pressure, the nucleus of the vagus nerve in the medulla oblongata is stimulated, blood flow to the left ventricle of the heart decreases, cardiac output falls, blood pressure decreases, sharp bradycardia and transient ischemia of the reticular formation of the brain stem occur, which leads to fainting. Most often, cough fainting occurs in men 35–40 years old, smokers and overweight. The frequency of attacks ranges from 2–3 attacks over 5–10 years to 10–12 attacks per day. Differential diagnosis should be carried out with epilepsy using electroencephalography. Treatment of bettolepsy includes therapy for the underlying disease – antibacterial, hormonal therapy, bronchodilators, antitussive drugs; due to positive effect of gabapentin, opinion about the neuropathic nature of the disease has been suggested. This literature review discusses the physiology of cough, etiology, pathogenesis, clinical picture, diagnosis and treatment options for cough syncope, clinical cases, and provides data from articles by Russian-speaking and foreign authors.