What do we know about how humans cough?

We review the evidence that activation of the cerebral cortex can lead to movements of the vocal folds and possibly to cough. Electrical stimulation of the motor cortex can cause movements of the vocal folds and vocalizatioin, but cough has not been reported. The motor pathways are via the nucleus ambiguous and possibly the nucleus retroambuigualis in the brainstem. In humans, activation of the cerebral cortex by transcranial magnetic stimulation can cause motor potentials in the intrinsic laryngeal muscles and corresponding surface potentials. The relationships between the cortical sensation related to cough, the voluntary control of cough and the involvement of reflex pathways remain to be clarified. (C) 2004 Elsevier Ltd. All rights reserved.