Treatment of Intractable Hiccups With Olanzapine Following Recent Severe Traumatic Brain Injury

Alderfer, B. S.; Arciniegas, David B.

doi:10.1176/appi.neuropsych.18.4.551

Cited by 10 publications

(11 citation statements)

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“…Cerebellar artery aneurysm also reported to result in hiccup and that was effectively treated after surgery 20. Brain injury may cause intractable hiccup 21. It is apparent that a carefully taken history regarding CNS is very important when we encounter these subjects with persistent or intractable hiccup.…”

Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

“…Besides, 5-HT agonist, for example, tandospirone (affinity to 5-HT 1A ) was also promising to treat stroke related hiccup because of direct inhibition of phrenic nerve activity via centrally located receptors 11. Olanzapine, a serotonergic antagonist with action on post-synaptic receptors, was also used to diminish the phrenic motor neuron activity to treat hiccup of a brain injury case 21. Midazolam, a benzodiazepine, acts on benzodiazepine receptors to form the benzodiazepine-GABA receptor-chloride ionophore complex in gating chloride channels which leads to hyperpolarization to inhibit neuron firing and to decrease neuronal depolarization.…”

Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

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Hiccup: Mystery, Nature and Treatment

Chang¹,

2012

J Neurogastroenterol Motil

161

173

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Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. The abrupt air rush into lungs elicits a "hic" sound. Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. A reflex arc involving peripheral phrenic, vagal and sympathetic pathways and central midbrain modulation is likely responsible for hiccup. Accordingly, any irritant in terms of physical/chemical factors, inflammation, neoplasia invading the arc leads to hiccups. The central causes of hiccup include stroke, space occupying lesions and injury etc, whereas peripheral causes include lesions along the arc such as tumors, myocardial ischemia, herpes infection, gastroesophageal reflux disease and applied instrumentations on human body etc. Besides, various drugs (eg, anti-parkinsonism drugs, anesthetic agents, steroids and chemotherapies etc) are the possible etiology. An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. Finally, alternative medicines and remedies are convenient to treat hiccups with uncertain effect. In conclusions, hiccup is likely to result from lesions involving the hiccup reflex arc. The lesion may need to be localized correctly for ablative treatment in patients with intractable hiccup. Apart from lesion ablation, drugs acting on reflex arc may be effective, while some other conventional measures may also be tried.

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Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

Hiccup: Mystery, Nature and Treatment

Chang¹,

2012

J Neurogastroenterol Motil

161

173

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“…The exclusion criteria included persistent hiccups mainly associated with cancer [21], multiple sclerosis [22], meningitis [23], brain abscess [24], traumatic brain injury [1], encephalitis [25], spinal cord lesions [26], kidney failure [27], pneumonia [28], laryngitis [29], and cardiorespiratory arrest [30]; rejection of baclofen therapy; and failure to complete clinical treatment.…”

Section: Methodsmentioning

confidence: 99%

“…This action is rapidly accompanied with uncontrollable inhalation and a sudden closure of the respiratory tract by the epiglottis, resulting in the classic “hic” sound [1,2]. Episodes of hiccups often start with sudden inspiration and end with abrupt closure of the glottis.…”

Section: Introductionmentioning

confidence: 99%

Baclofen for stroke patients with persistent hiccups: a randomized, double-blind, placebo-controlled trial

Zhang

et al. 2014

Trials

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BackgroundThe results of preclinical studies suggest that baclofen may be useful in the treatment of stroke patients with persistent hiccups. This study was aimed to assess the possible efficacy of baclofen for the treatment of persistent hiccups after stroke.MethodsIn total, 30 stroke patients with persistent hiccups were randomly assigned to receive baclofen (n = 15) or a placebo (n = 15) in a double-blind, parallel-group trial. Participants in the baclofen group received 10 mg baclofen 3 times daily for 5 days. Participants assigned to the placebo group received 10 mg placebo 3 times daily for 5 days. The primary outcome measure was cessation of hiccups. Secondary outcome measures included efficacy in the two groups and adverse events.ResultsAll 30 patients completed the study. The number of patients in whom the hiccups completely stopped was higher in the baclofen group than in the placebo group (relative risk, 7.00; 95% confidence interval, 1.91–25.62; P = 0.003). Furthermore, efficacy was higher in the baclofen group than in the placebo group (P < 0.01). No serious adverse events were documented in either group. One case each of mild transient drowsiness and dizziness was present in the baclofen group.ConclusionsBaclofen was more effective than a placebo for the treatment of persistent hiccups in stroke patients.Trial registrationChinese Clinical Trials Register: ChiCTR-TRC-13004554

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“…Guelaud and colleagues reported significant improvement in hiccups in 28/37 patients taking baclofen (with complete resolution in 18 cases) for IH [56], and Ramirez and Graham have performed the only randomized control study to date (although it only contained 4 patients) showing that Baclofen decreased the severity but not frequency of IH [57]. Success has been seen with a number of other agents including but not limited to nefopam [58,59], lidocaine [60,61], nifedipine [62], sertraline [63], olanzapine [64], benzatropine [65], carvedilol [66],amantadine [67], amitriptyline [68], midazolam [31,69] and general anaesthesia [70].Various forms of acupuncture have no less robust evidence than any of the aforementioned potential treatments and as a barely invasive procedure and one with no side effects, is certainly an alternative to, or an option for those refractory to medical therapy [71][72][73][74][75].…”

Section: Treatmentmentioning

confidence: 99%