Hiccups in Parkinson’s disease: an analysis of cases reported in the European pharmacovigilance database and a review of the literature (original) (raw)
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Journal of Personalized Medicine
Parkinson’s disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. We report three common but overlooked symptoms in PD—hiccups, hypersalivation, and hallucinations—in terms of their prevalence, pathophysiology, and up-to-date evidence-based treatment strategies. Whilst all these three symptoms do occur in many other neurological and non-neurological conditions, early recognition and treatment are paramount. Whilst hiccups affect 3% of healthy people, their rate of occurrence is higher (20%) in patients with PD. Hypersalivation (Sialorrhea) is another common neurological manifestation of many neurological and other neurodegenerative conditions such as motor neuron disease (MND), with a median prevalence rate of 56% (range: 32–74%). A 42% prevalence of sialorrhea is also reported in sub-optimally treated patients with PD. Hallucinations, especially visual hallucinations, are commonly reported, with a prevalence of 32–63% i...
Challenges in the Diagnosis and Treatment of Hiccup in Neurological Patients
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA
Hiccup is a prevalent event in the general population and can be found from milder, (so-called benign) to persistent and intractable forms. Hiccups have several causes, but stimulation of the phrenic nerve with compression, deformation and traction are among the most prevalent which could be consequence of mediastinal or lung cancer, gastric and/or esophageal distention, gastroesophageal reflux, instruments (catheters and intubation), cholecystitis, pericarditis or neurological causes. The objective of this paper is to stablish one treatment protocol and hiccup treatment in acute, persistent and intractable stages. A literature review was performed at Scielo, Pubmed, Ebsco, Clin Neuropharmacol, and ScienceDirect databases. Articles and publications from 1970 to 2015 were selected. The relevance of this article is the challenge for diagnostic and the difficulty to stablish the best plan to be addressed in cases of persistent or intractable hiccups in neurological patients, since they...
Punding in Parkinson's disease: The impact of patient's awareness on diagnosis
Movement Disorders, 2010
Hiccups can be an uncommon side effect of anti-parkinsonian therapy, recently reported in the literature. In these reports, dopamine agonists (DAs) (pramipexole, piribedil, and pergolide) 1,2 seem to play a causative role as hiccups began increasing the dose and subsided when the drug was stopped. In the first case, 2 hiccups started with pramipexole 3 mg per day and ended after drug discontinuation; another patient had hiccups after piribedil 100 mg per day 2 which stopped after tapering the dose to 50 mg per day, whereas in another case pergolide was associated with hiccups at high and not at low doses. 3 Very recently also levodopa (L-dopa) intake 500 mg per day lead to severe hiccups in an old patient with de novo parkinsonism 1 and some cases were also described in the past in a French vigilance survey 4 after L-dopa therapy.
Pharmacologic Interventions for Intractable and Persistent Hiccups: A Systematic Review
The Journal of Emergency Medicine, 2017
Background: Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups; however, many other pharmacologic treatments have been proposed for intractable and persistent hiccups. Currently, there is little evidence to support the use of one agent over another. Objective: This review aims to identify literature concerning the use of pharmacologic treatments for intractable and persistent hiccups with the goal of evaluating therapies in terms of their level of evidence, mechanism of action, efficacy, dosing, onset of action, and adverse effects. Methods: A systematic literature search of PubMed, Embase, the Cochrane Library, and the New York Academy of Medicine was performed to find articles where a pharmacologic agent was used to treat intractable or persistent hiccups between the years 1966 and 2016. The GRADE method was used to assess the level of evidence for the studies included in this review. Results: This review identified 26 articles involving 10 pharmacologic treatment options that met our inclusion criteria. Amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid were found in the literature to be successful in treating hiccups. Conclusion: Baclofen, gabapentin, and metoclopramide were the only agents that were studied in a prospective manner, while only baclofen and metoclopramide were studied in randomized controlled trials. No specific recommendations can be made for treating intractable and persistent hiccups with the evidence currently available in the literature. Therapy selection should be specific to individual patients, their underlying comorbidities, etiology of hiccups, and take into account the individual properties of the drugs.
Systemic review: the pathogenesis and pharmacological treatment of hiccups
Alimentary pharmacology & therapeutics, 2015
Hiccups are familiar to everyone, but remain poorly understood. Acute hiccups can often be terminated by physical manoeuvres. In contrast, persistent and intractable hiccups that continue for days or months are rare, but can be distressing and difficult to treat. To review the management of hiccups, including a systematic review of reported efficacy and safety of pharmacological treatments. Available articles were identified using three electronic databases in addition to hand searching of published articles. Inclusion criteria were any reports of pharmaceutical therapy of 'hiccup(s)', 'hiccough(s)' or 'singultus' in English or German. Treatment of 341 patients with persistent or intractable hiccups was reported in 15 published studies. Management was most effective when directed at the underlying condition. An empirical trial of anti-reflux therapy may be appropriate. If the underlying cause is not known or not treatable, then a range of pharmacological agen...
Dysphagia in symptomatic palatal tremor
Movement Disorders, 2010
Hiccups can be an uncommon side effect of anti-parkinsonian therapy, recently reported in the literature. In these reports, dopamine agonists (DAs) (pramipexole, piribedil, and pergolide) 1,2 seem to play a causative role as hiccups began increasing the dose and subsided when the drug was stopped. In the first case, 2 hiccups started with pramipexole 3 mg per day and ended after drug discontinuation; another patient had hiccups after piribedil 100 mg per day 2 which stopped after tapering the dose to 50 mg per day, whereas in another case pergolide was associated with hiccups at high and not at low doses. 3 Very recently also levodopa (L-dopa) intake 500 mg per day lead to severe hiccups in an old patient with de novo parkinsonism 1 and some cases were also described in the past in a French vigilance survey 4 after L-dopa therapy.
The Pathophysiology of Hiccups- a Comprehensive Review
2021
A hiccup is a sudden, repetitive involuntary contraction of the diaphragm and the intercostal muscles immediately followed by laryngeal closure. Hiccups are usually self-limiting, lasting up to a few minutes without any major clinical significance or the need for medical assistance. It may be the result of factors that trigger any of the three components of the reflex arc viz. the afferent limb, central limbic system or the efferent limb or any combination of neurotransmitters that assist the reflex arc. Despite its common occurrence, the pathophysiology and management of hiccups still remains unclear. Recent literature primarily consist of case reports which support the broad evidence of the numerous etiological factors and various drug treatments. Generally considered harmless, episodes of persistent or intractable hiccups may tend to have an underlying sinister pathology which may be easily overlooked. The etiopathogenesis has most often been attributed to lesions of the central ...
2021
Hiccup or hiccough is known by the medical term “singultus,” which is a derivative of the Latin word “singult,” meaning “a gasp” or “a sob” [1]. Hiccups are characterized by involuntary, intermittent, repetitive, myoclonic, and spasmodic contractions of the diaphragm and the inspiratory intercostal muscles, leading to an abrupt and early closure of the glottis, terminating inspiration and generating the characteristic “hic” sound [2,3]. Both healthy adults and children commonly experience hiccup spells. In the fetus, hiccups play a physiological role by training the respiratory muscles for their breathing function, and as a reflex preventing amniotic fluid aspiration [4,5]. Transient episodes usually do not Hiccups in neurocritical care Vanitha Rajagopalan, MBBS, MD, DNB, DM; Deep Sengupta, MBBS, DNB, DM; Keshav Goyal, MBBS, MD, DM; Surya Kumar Dube, MBBS, MD, DM; Ashish Bindra, MBBS, MD, DM; Shweta Kedia, MBBS, MD, MCh Department of Neuroanaesthesiology and Critical Care, Neuroscie...