I had short episodes of painful hiccups quite often for several years, they felt like spasms and didn't correlate with meals. Also for a long time my diaphragm would spasm at the end of the out breath. I haven't felt either though since starting Baclofen for other spasms and spasticity a few months ago.
I only occasionally get hiccups. I can usually control them reasonably well. I had not connected this with MS. I am aware of swallowing issues and I am more mindful to eat at a a slower pace. So far so good.
I always associated the hiccups with swallowing issues. It requires more muscular effort to swallow, which I assumed meant I was taking in more air in the process, increasing the risk of hiccups. They almost always come when I eat. Alcohol and rich food are particular triggers. I have become quite good at controlling them though, through deep breaths, holding my breath, a glass of water, etc.
2020 relapse - intractable nausea, constant hiccups and nasal regurgitation. Neuro ophth saw AP lesion and queried misdiagnosis but no spinal lesions. MS neuro - not MS LOL. Around 4 weeks. I then had a repeat last fall along with a new INO relapse. This time was given odansetron for the nausea and thankfully the hiccups weren’t quite as bad! So perhaps MS? Now on Kesimpta and all inflammation settling down.
I get hiccups much more often after MS, and trouble swallowing and/or eating small foods like rice without tucking my chin can set off "good" round of them. Typically it lasts an hour or two despite trying everything to get rid of them. If I didn't persistently try to rid myself of them, I'm certain they'd last much longer. My first clinical relapse featured some pretty significant brainstem symptoms (constant vertigo, nausea, vomiting, nystagmus, ataxia, sensitive hearing, swallowing issues, etc.).
Since taking Baclofen, Gabapentin and Lemtrada they seem to happen much less. I did also have a bit of PBA in a later relapse that has greatly reduced since but still occasionally gets me when hot and exhausted.
Nothing like the duration you describe but I hiccough far more easily than I used to. They come at odd and unrelated times. I need to stand up and hold my breath as much as possible. Were I to ignore them at onset they settle in and are then far harder to get rid of.
I am not sure, she is not my patient. I don't think hiccups helps too much clinically as this symptom/sign can occur in both conditions. The reason why it is so common in NMO is the fact that NMO frequently involves the area postrema in the medulla of the brain stem.
I agree, but the list of neurological conditions associated with hiccups is very long. In the setting of inflammation that looks like MS excluding NMO should be routine.
It’s always useful to learn about symptoms that one wouldn’t automatically assume to be a sign of relapse, so thank you for sharing this poor lady’s horrid experience.
I had to check my diary that it wasn’t 1st April. Hiccups! I can’t see it being in the top 100 of annoying MS symptoms (doesn’t come near to paralysis or vision loss!). What next - MS and bad breath, MS and in-growing toe nails? We need you back in the lab organising an anti-ebv trial rather than writing stuff on rare and mildly inconvenient MS symptoms. As a declared Corbynista, shouldn’t you be outside The Royal London waving a placard for hight pay etc.? I’m not sure today's post is worthy of minimum wage.
Do you think I should be striking? I can't. The BMA didn't ballot academic clinicians who are employed by Universities. Saying that I am very ambivalent about striking; I didn't become a doctor for financial remuneration.
If you’ve ever had persistent harsh hiccups you may have a different view. Clearly paralysis and vision loss is extremely difficult.
I get them often. Have had them for months on end with some days of respite. Sometimes they are so hard I partially vomit. The worrying thing is are they MS or are they not been considered as a symptom of something more sinister. Due to difficulty getting appointments these symptoms can be over looked, whilst other problems are bubbling up. Please don’t be little you haven’t experienced.
I find your comment offensively abusive toward the article author, as well as ignorant of the impact of persistent hiccups. Can you imagine being in a good state of mind after having hiccuped at 5 or 10-second intervals, 24 hrs a day, for six weeks?
I wouldn't take it too seriously. This is how fellow Brits chide each other along. Ian has been doing it for years. He does forget I am clinician on the coal face and writing MS-Selfie Newsletters is my way of helping pwMS and providing education to a wider audience.
Yes, I have had them for stretches for up three-four days. The marathon hiccups have only started since my MS diagnosis. In my experience it starts off annoying, but gradually becomes quite frightening - it does get quite painful and they repeat more and more rapidly so I was left feeling like I was about to choke.
I feel like a total hypochondriac saying all this but I did end up in hospital. Baclofen was tried. But what calmed it down was a very heavy tranquiliser (it's in the BNF for 'intractable hiccups'). I wonder whether there might have been a bowel connection.
Weird coincidence was that the two worst bouts immediately followed my alemtuzumab infusions.
Personally, I haven't had unusual hiccups. But I have had nausea (unremitting), vomiting, and motion sickness for decades. 😱 Which I think must be part of my MS, but I haven't managed to get any help with it.
'Hiccups can be psychogenic in patients with extreme stress or as part of a somatisation disorder or malingering.' That was triggery, the NHS spent decades insisting my MS was that.
I had short episodes of painful hiccups quite often for several years, they felt like spasms and didn't correlate with meals. Also for a long time my diaphragm would spasm at the end of the out breath. I haven't felt either though since starting Baclofen for other spasms and spasticity a few months ago.
This sounds very much like MS-associated hiccups.
I only occasionally get hiccups. I can usually control them reasonably well. I had not connected this with MS. I am aware of swallowing issues and I am more mindful to eat at a a slower pace. So far so good.
I always associated the hiccups with swallowing issues. It requires more muscular effort to swallow, which I assumed meant I was taking in more air in the process, increasing the risk of hiccups. They almost always come when I eat. Alcohol and rich food are particular triggers. I have become quite good at controlling them though, through deep breaths, holding my breath, a glass of water, etc.
2020 relapse - intractable nausea, constant hiccups and nasal regurgitation. Neuro ophth saw AP lesion and queried misdiagnosis but no spinal lesions. MS neuro - not MS LOL. Around 4 weeks. I then had a repeat last fall along with a new INO relapse. This time was given odansetron for the nausea and thankfully the hiccups weren’t quite as bad! So perhaps MS? Now on Kesimpta and all inflammation settling down.
I get hiccups much more often after MS, and trouble swallowing and/or eating small foods like rice without tucking my chin can set off "good" round of them. Typically it lasts an hour or two despite trying everything to get rid of them. If I didn't persistently try to rid myself of them, I'm certain they'd last much longer. My first clinical relapse featured some pretty significant brainstem symptoms (constant vertigo, nausea, vomiting, nystagmus, ataxia, sensitive hearing, swallowing issues, etc.).
Since taking Baclofen, Gabapentin and Lemtrada they seem to happen much less. I did also have a bit of PBA in a later relapse that has greatly reduced since but still occasionally gets me when hot and exhausted.
I had hiccups episodes during relapse an/or steroids treatment. I strongly associate it with my MS. Baclofen and THC has helped me.
Nothing like the duration you describe but I hiccough far more easily than I used to. They come at odd and unrelated times. I need to stand up and hold my breath as much as possible. Were I to ignore them at onset they settle in and are then far harder to get rid of.
Could this patient with hiccups have NMO ?
I am not sure, she is not my patient. I don't think hiccups helps too much clinically as this symptom/sign can occur in both conditions. The reason why it is so common in NMO is the fact that NMO frequently involves the area postrema in the medulla of the brain stem.
Agree but NMO s?
hould be considered in the differential
I agree, but the list of neurological conditions associated with hiccups is very long. In the setting of inflammation that looks like MS excluding NMO should be routine.
It’s always useful to learn about symptoms that one wouldn’t automatically assume to be a sign of relapse, so thank you for sharing this poor lady’s horrid experience.
I had to check my diary that it wasn’t 1st April. Hiccups! I can’t see it being in the top 100 of annoying MS symptoms (doesn’t come near to paralysis or vision loss!). What next - MS and bad breath, MS and in-growing toe nails? We need you back in the lab organising an anti-ebv trial rather than writing stuff on rare and mildly inconvenient MS symptoms. As a declared Corbynista, shouldn’t you be outside The Royal London waving a placard for hight pay etc.? I’m not sure today's post is worthy of minimum wage.
Do you think I should be striking? I can't. The BMA didn't ballot academic clinicians who are employed by Universities. Saying that I am very ambivalent about striking; I didn't become a doctor for financial remuneration.
If you’ve ever had persistent harsh hiccups you may have a different view. Clearly paralysis and vision loss is extremely difficult.
I get them often. Have had them for months on end with some days of respite. Sometimes they are so hard I partially vomit. The worrying thing is are they MS or are they not been considered as a symptom of something more sinister. Due to difficulty getting appointments these symptoms can be over looked, whilst other problems are bubbling up. Please don’t be little you haven’t experienced.
I find your comment offensively abusive toward the article author, as well as ignorant of the impact of persistent hiccups. Can you imagine being in a good state of mind after having hiccuped at 5 or 10-second intervals, 24 hrs a day, for six weeks?
I wouldn't take it too seriously. This is how fellow Brits chide each other along. Ian has been doing it for years. He does forget I am clinician on the coal face and writing MS-Selfie Newsletters is my way of helping pwMS and providing education to a wider audience.
Yes, I have had them for stretches for up three-four days. The marathon hiccups have only started since my MS diagnosis. In my experience it starts off annoying, but gradually becomes quite frightening - it does get quite painful and they repeat more and more rapidly so I was left feeling like I was about to choke.
I feel like a total hypochondriac saying all this but I did end up in hospital. Baclofen was tried. But what calmed it down was a very heavy tranquiliser (it's in the BNF for 'intractable hiccups'). I wonder whether there might have been a bowel connection.
Weird coincidence was that the two worst bouts immediately followed my alemtuzumab infusions.
Personally, I haven't had unusual hiccups. But I have had nausea (unremitting), vomiting, and motion sickness for decades. 😱 Which I think must be part of my MS, but I haven't managed to get any help with it.
'Hiccups can be psychogenic in patients with extreme stress or as part of a somatisation disorder or malingering.' That was triggery, the NHS spent decades insisting my MS was that.