BACKGROUND: Intractable hiccups (IH), defined as symptoms lasting longer than one month, can lead to significant morbidity and often fail to respond to standard medical and interventional therapies. Peripheral nerve stimulation (PNS) of the phrenic nerve represents a novel, mechanism-based treatment approach targeting the efferent limb of the hiccup reflex arc.

CASE REPORT: A 50-year-old man with a 3-year history of IH refractory to multiple medications and an external vagus nerve stimulator underwent a left phrenic nerve PNS trial. During the 60-day trial, hiccup episodes decreased from 10-15 days to 2 days, with prolonged symptom-free intervals. Following lead explant, the patient experienced shorter, more predictable episodes. Given the response, a subsequent contralateral (right-sided) phrenic nerve PNS trial was performed, resulting in a symptom-free interval of 15 days, the longest symptom-free interval reported by the patient.

CONCLUSIONS: Phrenic nerve PNS may offer a safe, minimally invasive reversible option for patients with refractory IH when conventional therapies fail.

KEYWORDS: Intractable hiccups, neuromodulation, peripheral nerve stimulation, phrenic nerve