Phrenic nerve Stimulation (diaphragm pacing) in chronic singultus

Abstract

The authors implanted a diaphragm pacer in a 71-year-old man who had suffered for two years from continuous hiccup of unknown cause with resulting insomnia. Preoperative transcutaneous stimulation of the phrenic nerves in the neck resulted in diaphragm contractions but did not affect his hiccup. Postoperatively, the patient was free of symptoms for two weeks. Electrophrenic stimulation was then initiated and after three days his hiccup disappeared again. After a ten day period without stimulation his hiccup recurred. For ten months the patient has suffered from hiccup only in the day time during which time he has also used the pacer. With a few exceptions he has been free of symptoms and without pacing during the night, which enables him to sleep normally. The effect of phrenic nerve stimulation on hiccup could be due to interference with the abnormal activation of the phrenic nerve, whatever its cause.

Evolution of Neuromodulation

“…A commercial phrenic nerve stimulator was made in 1978 by Dobelle of the Avery Company. A large experience in this technique was reported in 1984 by Fodstad and Blom [84] . The recent interest in long-term management of high cervical quadriplegics promises to call further attention to this technique.…”

Vagus nerve stimulation for chronic intractable hiccups

“…2,8,11,16,17 Pharmacotherapy for intractable hiccups includes dopaminergic antagonists such as chlorpromazine and haloperidol; antiarrythmics such as nifedipine, lidocaine, and phenytoin; and other medicines such as metoclopramide, baclofen, and gabapentin. 1,4 In the patient in the present case whose hiccups had a central origin and began following a posterior fossa stroke, administering a phrenic nerve block was effective only when accompanied by a vagus nerve block. 5,21 Although the phrenic nerve is believed to be the only motor nerve innervating the diaphragm, an accessory phrenic nerve may supplement it.…”

Hiccup in adults: an overview

“…Cooling [42,81,82] Local anaesthetic injection [81,83,84] Compression of phrenic nerve at the neck [85,86] Phrenic nerve stimulation [7,84,87] Phrenic crush or section:…”

“…Consequences of chronic hiccup depend upon the length of the attack, but also upon the underlying physiological status. In prolonged hiccup attacks, eating or sleeping may be impaired (7-16, 59, 109], leading to weight loss, exhaustion, or anxiety and depression [9,10,16,29,84,110]. In debilitated patients, particularly during acute myocardial infarction, persistent hiccup can slow down the recovery process, and even threaten the patient's life and warrant drastic therapeutic measures [51,69,81,[91][92][93][94].…”