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Coughing is a reflex phenomenon that is protective for the upper airways, involving both a reflex arc in the brainstem and cortical control. Ictal coughing has been prominently reported in temporal lobe seizures, but precise anatomo-electrical correlations are lacking. We report a patient who presented with persistent coughing at seizure onset. We studied intracerebrally recorded seizures (using stereo-electroencephalography) in order to describe the anatomo-functional correlations associated with this sign. Coughing followed seizure onset in the medial temporal lobe. A functional connectivity study (h2 estimation of interdependencies) showed that during coughing, a network of cortical and subcortical regions was involved, particularly the perisylvian cortices and the caudate nucleus.