David S. Jevotovsky MD, MBA1

, Michael Suarez DO2

, Harman Chopra MD2

, Bryan J. Marascalchi MD3

1NYU Langone Health

2Johns Hopkins University School of Medicine

3Vanderbilt University Medical Center

Department of

Rehabilitation Medicine

Rusk Rehabilitation

Peripheral Nerve Stimulation of the Phrenic Nerve for Intractable Hiccups:

A Novel Use Case Report

INTRODUCTION

- Intractable hiccups cause significant morbidity

- Hiccup management frequently presents a significant

clinical challenge, requiring innovative approaches

beyond conventional treatments.

- Emerging studies have indicated the moderate efficacy

interventional techniques.

- This case report details the novel use of phrenic nerve

peripheral neuromodulation in the management of a

patient w ith intractable hiccups, highlighting its

relevance to both clinical practice and the scientific

community due to the condition's rarity and the

procedure's pioneering nature.

METHODS

- 73-year-old African American male presented w ith

intractable hiccups

- Hindered his ability to eat, severely impaired his speech,

and disrupted his sleep, allow ing only 2-3 hours of rest

at a time.

- Conservative therapy, phrenic nerve and stellate

ganglion blocks, and external vagal nerve stimulation

w ere ineffective.

- He underw ent bilateral phrenic nerve ultrasound-guided

implantation of a Sprint peripheral nerve stimulator

(PNS).

- The Hiccups Assessment Instrument (HAI), w hich

subjectively measures hiccup severity, initially scored

the patient's hiccups as a moderate 6 out of 10.

RESULTS

- Follow ing PNS implantation and removal,

the patient's HAI score w as a “mild” 2 out

of 10.

- The decrement w as clinically meaningful

to the patient. He reported enhanced

functionality and quality of life including

the ability to sing at church and have

extended conversations w ith family

members.

- At four-months, his HAI w as 4 out of 10.

CONCLUSION

- This report show cases, to our know ledge,

a novel use for peripheral nerve

stimulation for the management of

intractable hiccups.

- Further investigation is needed to explore

long-term outcomes and applicability.