INTRACTABLE HICCUPS DURING STROKE REHABILITATION

Objective: To study the frequency of intractable hiccups during stroke rehabilitation and the impact on rehabilitation management. Design: C ase series, retrospective chart review. Setting: Inpatient stroke reha bilitation floor within a tertiary care teaching hospital. Patients: T hree patients admitted for stroke rehabilitation with hiccups of at le ast 48 hours out of 270 consecutive cases. Interventions: None. Main O utcome Measure: Response to pharmacologic treatment. Results: All thre e subjects had pontine infarcts and required gastrostomy tube feedings and lengthy rehabilitation stays. Subjects suffered from significant complications including aspiration pneumonia, respiratory arrest, and nutritional depletion. Chlorpromazine treatment was terminated in all three subjects because of sedation that interfered with therapies. Tre atment with carbamazepine was successful in only one patient; in the o ther two subjects, their hiccups were controlled with haloperidol or b aclofen. All subjects were ultimately managed with a single agent. Con clusions: Pharmacologic interventions for intractable hiccups must be tailored to the unique circumstances of the stroke rehabilitation pati ent. Intractable hiccups can be associated with potentially fatal cons equences, and safe management may require an inpatient rehabilitation setting and multidisciplinary team approach to optimize the feeding ma nagement of this challenging population. (C) 1998 by the American Cong ress of Rehabilitation Medicine and the American Academy of Physical M edicine and Rehabilitation.