Vagus nerve stimulation for chronic intractable hiccups

Abstract

Intractable hiccups are debilitating and usually a result of some underlying disease. Initial management includes vagal maneuvers and pharmacotherapy. When hiccups persist despite medical therapy, surgical intervention rarely is pursued. Cases described in the literature cite successful phrenic nerve blockade, crush injury, or percutaneous phrenic nerve pacing. The authors report on a case of intractable hiccups occurring after a posterior fossa stroke, Complete resolution of the spasms has been achieved to date following the placement of a vagus nerve stimulator.

Refractory central supratentorial hiccup partially relieved with vagus nerve stimulation

“…If unsuccessful, many alternative treatments are available, but those of neurosurgical interest are the inhibition or pacing of the phrenic nerve,3 or the stimulation of the vagus nerve 4. Intractable hiccups of central origin are associated with a bilateral diaphragm contraction; therefore, a unilateral block of the phrenic nerve is ineffective to relieve hiccups.…”

Persistent hiccups after acute supratentorial stroke: Report of seven cases and review of literature

“…[3,[17][18][19][20] Other options include gabapentin, cisapride and proton pump inhibitors and nonpharmacologic procedures like vagus nerve stimulation. [21,22] CONCLUSION We conclude that though hiccup is not life-threatening for the most part, persistent hiccups can increase morbidity after acute stroke and prompt use of oral baclofen, in addition to treating any identified underlying cause(s), is advised. [2,3,20] …”

Management of Intractable Hiccups

“…29 Both phrenic and vagal nerve stimulation have been found to relieve intractable hiccups and in one study was administered via a transcutaneous route with excellent effect. 30,12 Discussion This case highlights the challenges in identifying the exact cause and managing intractable hiccups in a patient with a hematological malignancy following a BMT. Our patient's gender seems to align with previous research showing a relatively high male predominance of those presenting with a complaint of hiccups following cytotoxic therapy.…”