Department of Neurology, Boston Medical Center/Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA.
BMC Neurol. 2023 Aug 10;23(1):297. doi: 10.1186/s12883-023-03352-x.
Hiccups (medically termed, "singultus"), when intractable, can cause significant medical consequences such as aspiration, malnutrition, and depression, leading to poor quality of life. Several case reports have shown that vagus nerve stimulator (VNS) implantation can help treat central idiopathic intractable hiccups. However, we present a contrary case of a patient who developed intractable singultus following VNS placement for medically refractory epilepsy.
We report a 71-year-old male patient with drug-resistant epilepsy who underwent VNS implantation and developed intractable hiccups shortly thereafter. The hiccups were severe and persistent, such that the patient developed a Mallory-Weiss tear, which required intensive care, invasive intubation and mechanical ventilation, and a prolonged rehabilitation course. Despite multiple therapies including phrenic nerve block and Nissen fundoplication, the patient's hiccups persisted and only stopped once the VNS was permanently deactivated.
Little is known about the incidence of hiccups after VNS implantation. We present one case of hiccups as a direct consequence of VNS implantation. The clinical impact of this report is significant given the relative unfamiliarity of hiccups as an adverse effect of VNS implantation. Neurologists and epileptologists, who present VNS implantation as a surgical option for seizure control to their patients, should be aware of the possibility of singultus development and its significant physical and emotional ramifications.
打嗝（医学上称为“呃逆”），如果难以控制，可能会导致严重的医疗后果，如吸入、营养不良和抑郁，导致生活质量下降。有几例病例报告表明，迷走神经刺激器（VNS）植入可以帮助治疗中枢性特发性难治性呃逆。然而，我们报告了一个相反的病例，一名患者因药物难治性癫痫接受 VNS 植入后出现难治性呃逆。
我们报告了一名 71 岁男性患者，患有耐药性癫痫，接受了 VNS 植入，此后不久出现难治性呃逆。呃逆严重且持续，导致患者出现 Mallory-Weiss 撕裂，需要重症监护、有创插管和机械通气以及长时间的康复过程。尽管采用了多种治疗方法，包括膈神经阻滞和 Nissen 胃底折叠术，但患者的呃逆仍然持续，只有在 VNS 永久停用后才停止。
VNS 植入后发生呃逆的发生率知之甚少。我们报告了一例呃逆直接由 VNS 植入引起的病例。鉴于 VNS 植入后呃逆作为一种不良反应相对不常见，本报告的临床影响意义重大。向其患者提出 VNS 植入作为控制癫痫发作的手术选择的神经科医生和癫痫科医生应意识到呃逆发展的可能性及其对身体和情绪的重大影响。
