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BACKGROUND: Area postrema syndrome (APS), a rare childhood condition, manifests as intractable nausea and hiccups. APS has high diagnostic significance in neuromyelitis optica syndrome spectrum disorders (NMOSD) and can be the initial presentation of other critical diseases, including brainstem glioma. METHODS: We described two representative cases of unrelated Japanese patients with APS. An etiologic evaluation, including a detailed intracranial neuroradiological examination and autoantibodies assessment, was performed. We also reviewed the literature focusing on the prognosis of pediatric APS symptoms. RESULTS: A 14-year-old girl with aquaporin-4 antibody-positive NMOSD showed a good prognosis with immunotherapy, whereas another nine-year-old girl with irresectable medullary low-grade glioma had persistent symptoms for more than 10 years. All reported children aged >12 years were diagnosed with NMOSD, and patients aged <13 years showed heterogeneous etiologies. CONCLUSIONS: Distinctive time courses and neuroimaging features were key clinical findings for the diagnostic and therapeutic processes in these patients. This literature review highlights the wide spectrum and prognosis of pediatric-onset APS.

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Previous studies suggest that baclofen may be useful in the treatment of intractable hiccup caused by chemotherapy. This study was aimed to assess the possible efficacy and safety of baclofen. In total, 65 patients with intractable hiccup caused by chemotherapy were screened. 45 patients with intractable hiccup caused by chemotherapy were finally recruited. Participants in the trial received 10 mg baclofen three times daily for 3 days. The primary outcome measure was cessation of hiccups. Secondary outcome measures included efficacy and adverse events. All 45 patients completed the study. Among them, 41 cases were cured (91.11%, 41/45), 4 cases were relieved (8.89%, 4/45), and the overall effective rate was 100% (45/45). Furthermore, the median remission time was 2(1, 9) times, the median cure time was 2(1, 9) times, the remission rate of one-time was 13.33% (6/45), the remission rate of two-time was 53.33% (24/45), and 2 cases (4.44%, 2/45) relapsed after drug withdrawal. No serious adverse events were documented. Only 1 case (2.22%) had grade 2 fatigue and 2 cases (4.44%) had grade 1 sleepiness. Baclofen is safe and effective in the treatment of intractable hiccup caused by chemotherapy of malignant tumor.

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A 52-year old woman first noted dysphagia four months before admission followed by dysarthria two months later. She then developed weakness of all limbs and became unable to walk. All these symptoms, associated with tongue atrophy, slowly progressed, leading to the initial clinical impression of a motor neuron disease, although her nerve conduction study and electromyography showed no abnormalities. Her brain MRI with T2 weighted/diffusion weighted image (DWI)/fluid attenuated inversion recovery (FLAIR) revealed a high signal lesion located at dorsal medulla oblongata. She proved positive for anti-aquaporin 4 antibody, which confirmed the diagnosis of neuromyelitis optica spectrum disorders (NMOSD). We conclude that NMOSD may initially present with progressive bulbar palsy and pyramidal tract disorder over a few months, mimicking a motor neuron disease. Awareness of this atypical presentation helps establish an early diagnosis of this treatable entity.

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Objective: To evaluate the therapeutic effect of cervical Jiaji electroacupuncture on postoperative intractable hiccup of liver neoplasms. Methods: A total of 39 patients with postoperative intractable hiccup of liver neoplasms in The First Affiliated Hospital of Heilongjiang University of Chinese Medicine from May 2013 to May 2017 were collected and divided into 2 groups randomly. The electroacupuncture group included 20 cases, the control group included 19 cases. Patients in the electroacupuncture group were treated by cervical Jiaji electroacupuncture (located in C3-5, sympathetic ganglion), while the control group were treated by metoclopramide combined with chlorpromazine for three days. The therapeutic effects of two groups were compared and the onset time were recorded. Results: Total effective rates of electroacupuncture group and control group were 95.0% and 47.4%, respectively. The onset time in electroacupuncture group and control group were (14.8±3.3) h and (30.5±3.1) h, respectively (P<0.01). Ten cases who resisted the control treatment were then treated by electroacupuncture for 3 days, 6 cases were recovered, 3 cases became better, while 1 case demonstrated no response. No serious adverse reactions were appeared in each group. Conclusion: Cervical Jiaji electroacupuncture is an effective and safe treatment for postoperative intractable hiccup of liver neoplasms, and it can be used as a remedy for intractable hiccup patients who don't respond to drug treatment.

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Objective@#To evaluate the therapeutic effect of cervical Jiaji electroacupuncture on postoperative intractable hiccup of liver neoplasms.@*Methods@#A total of 39 patients with postoperative intractable hiccup of liver neoplasms in The First Affiliated Hospital of Heilongjiang University of Chinese Medicine from May 2013 to May 2017 were collected and divided into 2 groups randomly. The electroacupuncture group included 20 cases, the control group included 19 cases. Patients in the electroacupuncture group were treated by cervical Jiaji electroacupuncture (located in C3-5, sympathetic ganglion), while the control group were treated by metoclopramide combined with chlorpromazine for three days. The therapeutic effects of two groups were compared and the onset time were recorded.@*Results@#Total effective rates of electroacupuncture group and control group were 95.0% and 47.4%, respectively. The onset time in electroacupuncture group and control group were (14.8±3.3) h and (30.5±3.1) h, respectively (P<0.01). Ten cases who resisted the control treatment were then treated by electroacupuncture for 3 days, 6 cases were recovered, 3 cases became better, while 1 case demonstrated no response. No serious adverse reactions were appeared in each group.@*Conclusion@#Cervical Jiaji electroacupuncture is an effective and safe treatment for postoperative intractable hiccup of liver neoplasms, and it can be used as a remedy for intractable hiccup patients who don′t respond to drug treatment.

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Membranous nephropathy (MN) accompanying Neuromyelitis optica spectrum disorders (NMOSD) has rarely been described previously. We recently presented a 45-year-old Chinese male presenting with recurrent lower extremity pitting edema, or eyelid edema, proteinuria and hyperlipidemia. especially intractable hiccup and vomiting, painful tonic spasm (PTS) as the revealing symptom of a demyelinating disorder of central nervous system. The kindey biopsy specimen showed MN stage 2. Serological testing revealed antibodies AQP4, MRI head and spine revealed medulla oblongata and C1-C2 cervical vertebra lesions. Treatment with methylprednisolone, cyclophosphamide, azathioprine resulted in consistent clinical improvement.

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Objective To study the clinical features of patients with neuromyelitis optica (NMO) having initial symptom of intractable hiccup and nausea (INH) to improve the recognition of the disease.Methods Fourteen patients with NMO having INH as onset,admitted to our hospital from January 2015 to April 2016,were chosen.The onset characteristics,cerebrospinal fluid (CSF) results,serum aquaporins (AQP)4 antibody level,head and neck MR imaging of these patients were retrospectively analyzed.Results NMO with INH as onset was more common in young and middle-aged women;and the symptom was stubborn.Leukocyte increased slightly and total protein was normal or slightly increased in CSF.The positive rate of AQP4 antibody in serum was 79％ and oligoclonal band in CSF was 17％.MR imaging showed 8 patients (57％) had lesions in bulbar tegmentum and area postrema,6 patients (43％) had high cervical cord lesions without medullary lesion;most of the lesions in medulla oblongata and high cervical cord were linear;5 patients (36％) had abnormal signal of brain stem,corpus callosum and cerebral cortex.It was isointense or hypointensity on T1WI and hyperintense on T2WI and FLAIR sequences.Conclusions Antiemetic therapy of NMO with INH as onset is ineffective;the initial symptom is INH,followed by optic neuritis and/or myelitis symptoms.MR imaging shows lesions including bulbar tegmentum and area postrema,or linear signal changes in medulla and spinal cord.

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Objective To observe the clinical therapeutic effect of acupuncture combined with acupoint injection in the treatment of post -stroke intractable hiccup.Methods 120 patients with post -stroke intractable hiccup were randomly divided into treatment group(60 cases)and control groups(60 cases)according to the digital table.The patients in the control group were treated with baclofen tablets and methloxetamine hydrochloride injection, and the patients in the treatment group were treated with acupuncture combined with acupoint injection therapy.The treating period was 1 week.The scores of hiccup symptoms,the total effective rate and side effect were recorded before and after the treatment in all patients.Results The scores of hiccup symptoms before treatment in the treatment group and the control group were (5.32 ±1.17)points and (5.25 ±0.65)points respectively,there was no statistically significant difference between the two groups(t =1.79,P =0.96).The scores of hiccup symptoms on the 1 day after treatment in the treatment group and the control group were (3.97 ±1.24)points and (3.85 ±1.02 )points respectively,there was no statistically significant difference between the two groups(t =1.93,P =0.48).The scores of hiccup symptoms on the 3 days after treatment in the treatment group and the control group were (2.80 ±0.73)points and (3.75 ±1.11)points respectively,there was significant difference between the two groups(t =2.66,P =0.00), that in the treatment group was lower than the control group.The scores of hiccup symptoms on the 5 days after treatment in the treatment group and the control group were (2.25 ±1.07)points and (3.43 ±0.81)points respec-tively,there was significant difference between the two groups(t =2.85,P =0.00),that in the treatment group was lower than the control group.The scores of hiccup symptoms on the 7 days after treatment in the treatment group and the control group were (1.27 ±0.66)points and (2.02 ±0.98)points respectively,there was significant difference between the two groups(t =1.07,P =0.00),that in the treatment group was lower than the control group.The total effective rates in the treatment group and the control group were 90%(54 /60)and 65%(39 /60)respectively,there was significant difference between the two groups(χ2 =10.75,P =0.00).The incidence rates of side effects in the treatment group and the control group were 1.7%(1 /60)and 6.7%(4 /60)respectively,there was no statistically significant difference between the two groups(χ2 =0.84,P =0.36).Conclusion Acupuncture combined with acu-point injection can significantly reduce the hiccup symptom score of post -stroke intractable hiccup patients on the 3, 5 and 7 days after treatment,and improve the total effective rate.

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OBJECTIVE:To observe the clinical efficacy and safety of Cinobufacini capsule in the treatment of tumor patients with intractable hiccup. METHODS:120 tumor patients with intractable hiccup were randomly divided into observation group(60 cases) and control group (60 cases) according to the random number table. Control group received conventional treatment,treat-ment of primary disease,and the basic treatment of Methoxy metoclopramide tablets 10 mg,tid and intraorbital pressure on neural network method;observation group additionally received Cinobufacini capsule,2 capsules once,3 times a day. 1-week was regard-ed as a treatment course,and it lasted 4 courses. Clinical efficacy,Karnofsky functional status(KPS)score and disappearance time of hiccup were observed,and the incidence of adverse reactions was evaluated by TESS scale. RESULTS:After treatment,the to-tal effective rate in observation group was significantly higher than control group,the disappearance time of hiccup and TESS score were significantly shorter than control group,the differences were statistically significant(P<0.05). Before treatment,there was no significant difference in the KPS score;after treatment,the KPS score in 2 groups was significant higher than before,and observa-tion group was higher than control group,the difference was statistically significant(P<0.05). CONCLUSIONS:Both efficacy and safety of Cinobufacini capsule in the treatment of intractable hiccup are good,and it can shorten hiccup duration.

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This case report describes a man with intractable hiccups probably caused by donepezil. The patient's symptoms were not responsive to commonly used medications for hiccups, but they were improved and completely relieved upon donepezil dose deescalation and discontinuation. We report two occasions in which the discontinuation of donepezil resulted in hiccup resolution and three occasions in which initiation of donepezil was associated with the onset of hiccups. This report contributes to the growing body of literature that describes an association between centrally acting medications and intractable hiccups.

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BACKGROUND: Limited data exist regarding the efficacy of metoclopramide in the treatment of intractable hiccups. AIM: This study aimed to assess the feasibility efficacy of metoclopramide in the treatment of patients with intractable hiccups. METHODS: A total of 36 patients with intractable hiccups was randomly assigned to arm A (n = 18) or arm B (n = 18) in a multicentre, double-blind, randomised, controlled pilot study. Participants in arm A received 10-mg metoclopramide thrice daily for 15 days, whereas those assigned to arm B received 10-mg placebo thrice daily for 15 days. The primary outcome measure was total efficacy against hiccups (including cessation and improvement of hiccups). Secondary outcome measures included a comparison of overall efficacy and adverse events between the two arms. RESULTS: Of the 36 patients enrolled, 34 participants completed the study. The total efficacy was higher in arm A than in arm B (relative risk, 2.75; 95% confidence interval: 1.09-6.94, P = 0.03). Furthermore, comparison between the two arms revealed that overall efficacy was higher in arm A than that in arm B (P < 0.05). No serious adverse events related to the treatment were documented in either arm. The most common adverse events occurring in patients in arm A included fatigue, upset mood and dizziness. CONCLUSION: Metoclopramide appears to be a promising candidate for the treatment of patients with intractable hiccups, with mild adverse events. However, further clinical trials are required to confirm these results.

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No abstract available.

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Objective To investigate the clinical manifestations and MRI features in patients with neuromyelitis optica (NMO) leading to intractable hiccup and nausea (IHN). Methods We collected the data of 17 patients with NMO and analyzed the clinical profiles and MRI features in patients that also complicated with IHN. Results IHN was a common clinical manifestation in patients with NMO: of 17 with NMO, 8 were complicated with IHN (47.5%), having IHN and diplopia and nystagmus symptoms; 6 appeared MRI-detected linear medullary lesion (LML) and linear medullespinal lesion (LMSL) in the spinal cord. The cord lesions extended over three vertebral segments and centered on central canal of spinal cord; most cord lesions preferentially involved the posterior or lateral horn of spinal cord on axial T2. Conclusion NMO leading to IHN is clinically manifested by IHN, and diplopia, and a linear medullary or medullospinal lesion often appears in the spinal cord and medulla. The cord lesions are centered on the central canal of the spinal cord and mainly involve in the posterior or lateral horn of the spinal cord. All these manifestations and MRI features are the distinctive characteristics of NMO, which can be differentiated from multiple sclerosis.

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Objective To investigate the value of the acupuncture with Medicinal herbs in the treatment of the intractable hiccup after severe craniocerebral injury. Methods Sixty patients diagnosed of intractable hiccup after severe craniocerebral injury were randomly recruited into a therapeutic group and a control group. The therapeutic group was treated with acupuncture and medicinal herbs, while the control group was treated with western medicine. The therapeutic course for both groups was one week. The efficacy was evaluated by observing the cure rate, improvement rate and non effective rate respectively. Results In the therapeutic group :23 patients were cured and the total effective rate was 96.67%;While in the control group: 12 patients were cured and the total effective rate was 70.00%. The effective rate of therapeutic group was obviously better than the control group. Conclusion Acupuncture with medicinal herbs in the treatment of the intractable hiccup after severe craniocerebral injury has good efficacy.

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Pneumomediastinum and subcutaneous emphysema generally occurs following trauma to the esophagus or lung. It also occurs spontaneously in such situations of elevating intra- thoracic pressure as asthma, excessive coughing or forceful straining. We report here on the rare case of a man who experienced the signs of pneumomediastinum and subcutaneous emphysema after a prolonged bout of intractable hiccup as the initial presenting symptoms of multiple sclerosis.

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Hiccup can be regarded as a failure of the usual alternating excitation-inhibition between glottis closure and inspiration. The coordinating center is located in the brain-stem reticular formation. A wide variety of pathological conditions can cause intractable hiccup: myocardial infarction, brain tumor, renal failure, prostate cancer, abdominal surgery, etc. Stroke is an unusual cause of intractable hiccup. Intractable hiccup is rare but disabling condition which can induce depression, weight loss, sleep deprivation, and even death. Etiological treatment is not always available and intractable hiccup treatment has classically relied on metoclopramide and chlorpromazine. We experienced a case of intractable hiccup induced by multiple cerebral infarct, and we present this rare case with the review of literature.

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Intractable hiccups are defined as hiccup persisting for more than 48hours, and these appear in various diseases. A 28-year-old woman admitted due to intractable hiccups without gastroenteral system abnormalities and peripheral nervous systemic involvement. High signal intensity lesion of the medulla oblangata in the tegmental region was detected on T2-weighted MR imaging, which might be a causative etiology. We encountered a rare case developing intractable hic-cups as presenting symptom of 'clinically definte' multiple sclerosis.

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OBJECTIVE:To evaluate the therapeutic effect of Alprazolam on drug-induced intractable hiccup.METHODS:The relevant drugs which induced hiccup were first discontinued and the underlying diseases were actively treated.The trial group received Alprazolam tablets and control group Qiyeshenan tablets.RESULTS:The effective rate was84.4%in trial group and66.7%in control group with significant difference(P