Evidence for Sensory Neuropathy and Pharmacologic Management
Section snippets
Clinical evaluation
In diagnosing PVVN, the clinician must maintain a high level of suspicion. As with all clinical diagnoses, a thorough history is essential in providing clues to this potential cause. Many algorithms, such as the anatomic diagnostic protocol, are available to help guide the clinician in assessing the patient.2 Once the most common causes of chronic cough have been ruled out, further inquiry into potential viral illness surrounding the initial presentation of symptoms should be investigated. PVVN
Treatment options
Whereas several studies have provided objective evidence of vocal fold paresis following a previous viral illness, the majority of cases have been diagnosed through symptomatic presentation and taking a thorough history. At present, there is no standard of care for patients with suspected PVVN, but it has been recently suggested that treatment for PVVN be patient-specific and, therefore, tailored to individual presenting symptoms.7 The patient's specific triggers that induce cough should be
Method of action
Pregabalin is a γ-aminobutyric acid (GABA) analog that strongly binds to the alpha(2)-delta site in the central nervous system tissues. Binding to the alpha(2)-delta subunit may be involved in pregabalin's effects on neuropathic pain. Pregabalin reduces the calcium-dependent release of several neurotransmitters, including glutamate, noradrenaline, and substance P, possibly by modulation of calcium channel function; however, the exact mechanism of action is unknown. Currently, pregabalin has
Summary
PVNN, while a relatively new clinical diagnosis, has been observed and well described within the literature in recent years. As additional studies are reported, a growing body of anecdotal and empirical evidence suggests PVVN may be a distinct and treatable cause of idiopathic chronic cough. PVVN varies in presentation, but is most commonly seen in adult women with symptoms persisting long after resolution of an acute viral illness. Symptoms are classified according to the vagal branch most
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