Robert Smith has difficulty talking for very long. He also has trouble sleeping and eating, and he has lost more than 50 pounds in the last three years. He has even considered taking his life. The source of his misery? It sounds like a biblical curse in a Mel Brooks movie. “I hiccup every day and every night, with five or 10 minutes of relief at most,” said Smith, 53, a maintenance worker in Montgomery, Alabama.

Each hiccup involves a sharp intake of breath, accompanied by a sudden closing and opening of the vocal cords, producing the “hic” sound. For most people, hiccups are set off by eating too fast or by swallowing air, and they tend to go away on their own.

Smith is one of the rare people who suffer from chronic hiccups, and he does not know what caused them. He has tried holding his breath, drinking ice water and making himself vomit, all folk remedies for the spasms. He has trooped from gastroenterologists to internists to neurologists, because persistent hiccups can reflect underlying problems like reflux disease, metabolic abnormalities or brain disorders. Smith has tried so many drugs that “their names all blur together”, he said. Nothing has done much good.

Recently, he decided to try a new approach. Dr Bryan R. Payne, a neurosurgeon at the Louisiana State University Health Sciences Center in New Orleans, implanted in Smith’s upper chest a device that generates electrical pulses, a vagus nerve stimulator. It sends rhythmic bursts of electricity to the brain by way of the vagus nerve, which passes through the neck.

The Food and Drug Administration approved the vagus nerve stimulator in 1997 as a way to control seizures in some patients with epilepsy. Last year, the agency endorsed the use of the stimulator as a treatment of last resort for people with severe depression, despite controversy about its effectiveness for that. The treatment has not been approved, or even seriously studied, as an approach to chronic hiccups.

In June 2004, Payne and a colleague at LSU, Dr Robert L. Tiel, used the device to treat a Texan, Shane Shafer, 50, who had been hiccupping for almost a year. An earlier stroke had damaged areas of Shafer’s brain stem, Payne said, somehow setting off the chronic hiccupping, although the precise mechanism is not known.

Shafer “had essentially been tried on everything”, Payne says, including a major tranquilizer, chlorpromazine; a muscle relaxant, baclofen; and metoclopramide (Reglan) and domperidone, drugs for gastrointestinal disorders.

Because gastrointestinal problems can cause hiccups, doctors often try drugs that act on the digestive tract. But for Shafer nothing had worked.

Payne and his colleagues tried giving Shafer an injection of anaesthesia to numb a nerve involved in breathing. That, too, failed. But about 10 minutes later, Payne recalls, Shafer’s voice grew hoarse and, to the surprise of all present, the hiccups subsided, at least until the injection wore off. What had happened, the team reasoned, was that the anaesthetic had migrated and had temporarily blocked the activity of another nerve, the vagus, and that was what had quelled the spasms.

Many folk remedies for hiccups ? drinking cold water, eating a spoonful of sugar, stimulating the back of the throat and throwing up ? are actually forms of vagal stimulation, Tiel said, adding, “Many of them work, to a certain extent at least.”

He also noted that a small number of patients who received vagus nerve stimulation for epilepsy developed temporary cases of hiccups, indicating a possible overlap between the nervous pathways affected by the treatment and those involved in the hiccups.

There was reason to believe that the treatment, an intense and repeated form of vagal stimulation, might help Shafer. After the device had been implanted and activated, Shafer’s hiccups disappeared.

A flurry of television news broadcasts and newspaper articles followed, featuring Shafer as a medical success story. A detailed case report also appeared in May in The Journal of Neurosurgery. “Prior to that, we had not seen many cases” of persistent hiccups, Payne said.

Afterward, however, chronic hiccuppers from around the country began to call. “We now have a database of over 70 people who have contacted our department,” and many are interested in trying the stimulator, he said.

BRAIN WAVE: The revolutionary treatment is still classified as ‘unproved use’. (AFP)

Few people have received the treatment, mainly because it is so expensive, about $20,000 for the device and the surgery to implant it. Neither Medicare nor most health insurers will pay for what they classify as an unproved use.

Smith said that he worked hard to persuade his insurer, Blue Cross Blue Shield, to pay and that the company had agreed to cover 80 per cent of the costs. “After I explained everything to them,” he said, including how much they had already paid for drugs and doctors’ visits, “they called me back and said OK”.

He remains concerned, he said, about the money, approximately $4,000, that he would need to pay out of his own pocket, in addition to the repeated six-hour trips to New Orleans for follow-up visits.

Tiel and Payne expressed frustration that they were not able to offer free treatment to Smith and other patients. They said that they were asking for grants and trying to obtain financing for a clinical trial, but that research money for the disorder were hard to come by.

“If it’s a cardiac arrhythmia, everyone understands,” Tiel said. “If it’s a hiccup, people laugh.”

Dr. Russell K. McAllister, an assistant professor of anesthesiology and pain medicine at the Texas A&M College of Medicine-Scott & White Memorial Hospital, said, “There are few or no controlled studies out there on hiccups treatment.”