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The clinical features of seven patients with persistent hiccup are reported. Hiccup did not respond to the usual therapies and resolved with baclofen. The administration guidelines and secondary effects are discussed. The authors suggest baclofen should be considered the drug of choice for treating persistent hiccup.
Two patients with chronic hiccup and MRI demonstrated lesions at the level of the inferior olivary complex are here reported. Whereas the neurological examination was normal in case 1, case 2 had the syndrome of palatal myoclonus and progressive ataxia. In the case 1, extensive electrophysiological studies were consistent with hiccup, in the absence of any other disorder (in particular, there was no evidence of palatal myoclonus). These findings suggest that the dysfunction of the inferior olivary complex could be implicated in the pathogenesis of hiccup.
Twelve patients who developed hiccup during anaesthesia and surgery were treated successfully with an intravenous injection of ephedrine 5 mg (eleven cases) or 10 mg (one case). In nine patients ephedrine was successful after traditional methods had been tried and failed, and in three patients ephedrine was the only agent given. We conclude that ephedrine is a safe and easy mode of treatment for intractable hiccup during anaesthesia and surgery.
In a 56-year-old man with metastatic small-cell lung cancer, a persistent hiccup was refractory to classic treatments. Hyponatremia, neoplasic mediastinal involvement and liver metastases were though to be potential causative factors. Methylphenidate (MTP), a mild central nervous system (CNS) stimulant that is most commonly used for the treatment of attention deficit hyperactivity disorder, was started at a daily dose of 10 mg. It was rapidly efficient and well tolerated. This report suggests a potential advantage of MTP in the treatment of intractable hiccup in cancer patients.
The present study has revealed that a hiccup-like response (a brief powerful inspiratory activity accompanied by glottic adduction) can be generated by electrical stimulation to a limited area within the medullary reticular formation of the cat. This finding indicates that there is a neuronal network coordinating the hiccup reflex within the lower brain stem.
We describe two terminally ill cancer patients severely distressed by intractable hiccup. Commonly recommended treatments were ineffective. Intravenous midazolam 5-10 mg rapidly relieved the hiccup. Maintenance treatment comprised midazolam 40-120 mg/24 hr by continuous subcutaneous infusion.
We present the case of a patient who presented with persistent hiccups induced by a hair irritating the tympanic membrane and activating the vagally mediated hiccup neural reflex arc. Commonly identified etiologies and treatments of this condition are then reviewed.
IMPLICATIONS: We describe three patients in whom hiccups were treated successfully by atropine. Although further clinical investigation is needed, atropine may be useful in the treatment of hiccups after the laryngeal mask airway insertion.
IMPLICATIONS: Chronic hiccups may be a serious therapeutic problem. Pharmacological treatment with increasing dosages of baclofen, carbamazepine, or gabapentin is not always successful. In this paper, the use of general anesthesia with positive-pressure ventilation and muscle relaxation for the termination of chronic hiccups is described.
To suppress intractable neurologic hiccups that were unresponsive to pharmacologic management, seven patients have been implanted with modern breathing pacemakers of our design and manufacture. These devices control excursions of the diaphragm by electrical stimulation of the phrenic nerve. The first five patients have been able to control their hiccups by electrical stimulation after periods of up to 13 years. Two additional patients have been recently implanted and results are still pending.
The word "hiccup" refers to an involuntary, spasmodic contraction of the diaphragm that is followed by the abrupt closure of the glottis to produce the characteristic sound. Among the many documented causes of this occurrence are those due to neurogenic dysfunction. In the past few decades, lidocaine has been shown to be effective in treating a variety of disorders thought to involve neuropathic mechanisms, including seizures, chronic pain, and arrhythmias. We describe a postsurgical patient in whom two successive intravenous infusions of lidocaine, 1.5 mg/kg followed the next day by 0.75 mg/kg, terminated his hiccup twice, whereas multiple other treatments failed to alleviate the problem. Various causes of this phenomenon are discussed, as well as a possible mechanism for the successful treatment.
A patient with multiple sclerosis (MS) who developed intractable hiccups and syncope due to a cervical cord lesion is reported. Previous case reports of intractable hiccups occurring in MS have all been located in the medulla oblongata. Our patient is the first case with the responsible lesion in the cervical cord. The pathophysiological mechanism of the syncopal attacks in this case were thought to be same as that of cough syncope.
A case of persistent hiccup associated with cavitating pulmonary tuberculosis is reported. Though tuberculosis presenting with hiccup is rare, tuberculosis is again on the increase and clinicians should remain alert to the possibility of this diagnosis.
A case is reported of a patient with periodic persistent hiccups and secondary generalised epilepsy lasting for a period of five years following a right temporal brain abscess. The recurring episodes of hiccups had a ten day rhythmicity and unlike epileptic convulsions were unresponsive to treatment.
Hiccups has not been previously reported as a manifestation of Addison's disease. We report two cases where persistent hiccups was an early feature of Addison's disease. Steroid replacement cured the symptoms in both patients with no recurrence.
Two patients with intractable hiccups were treated with intramuscular haloperidol; remission occurred within 1 hour. With its rapid action and low incidence of adverse effects, intramuscular haloperidol should be considered a therapeutic alternative in the treatment of intractable hiccups.
Metaclopramide has been observed to induce dramatic relief of intractable hiccup in 14 patients with diverse serious illnesses. When given orally or parenterally the effect was observed within 30 minutes, the relief lasting up to 8 hours, indicating a direct relation to the duration of action of the drug. This drug is recommended for symptomatic relief of hiccup associated even with serious organic illnesses, without any fear of undesirable effects.
An infarctus of medulla oblongata was discovered in a 44-year old man with an intractable hiccup and 10, 11th and 12th right cranial nerves palsies. Systemic lupus erythematosus (SLE) with antiphospholipid syndrome was subsequently diagnosed. Hiccup has withdrew with corticosteroid therapy and low-dose aspirin. The other cases of literature and pathophysiologic hypotheses are briefly reported.