A
hiccup is a
myoclonic jerk of the diaphragm, and cases of
hiccups may last for more than 48 hours (persistent
hiccups) or even more than 2 months (intractable
hiccups). Current pharmacologic treatment of persistent or intractable
hiccups mainly includes antidopaminergic drugs. We describe the case of a 60-year-old man with a recent diagnosis of right insular
ischemic stroke who presented with frequent, intense, and disabling
hiccups for more than 1 month. As diagnosis of poststroke
hiccups was assumed, the patient was treated over the next 6 months with adequate doses of various
antipsychotic drugs commonly used for the treatment of
hiccups; however, all were discontinued because of adverse effects. Indeed,
dyskinesia after
chlorpromazine (up to 75 mg/day for 4 wks), as well as
somnolence and
dyskinesia after
haloperidol (up to 6 mg/day for 6 wks),
somnolence after
gabapentin (up to 1800 mg/day for 8 wks), and severe
somnolence and
hypotension after
baclofen (up to 50 mg/day for 6 wks) were reported. The patient was then prescribed
tetrabenazine at a starting dose of 12.5 mg twice/day (25 mg/day), with a nearly complete remission of the
hiccup symptomatology after ~6 weeks, when a daily dose of 150 mg was reached. We therefore hypothesize that a supratentorial lesion may disrupt the modulation of dopaminergic pathways involved in the regulation of medullar centers responsible for the
hiccup reflex. To our knowledge, this is the first case report of poststroke
hiccups responding to
tetrabenazine. The dramatic response of our patient to
tetrabenazine monotherapy suggests that this
drug may be a valuable pharmacologic alternative for patients with
hiccups after
stroke who are intolerant or unresponsive to classic
antipsychotic agents.