Background - Recurrent NMS can be a disabling disorder poorly responding to medical therapy. Orthostatic training has been reported to be effective in reducing recurrence of NMS. We evaluated the effectiveness of a home orthostatic self-training program to prevent NMS in a pediatric population.


Methods - We studied 20 pts ( 12 females, mean age 10 , 6-16 years ) with recurrent ( 3.5 +/-2.5 mean number of syncopes in the last year ) NMS and a positive head-up tilt test.
The patients performed the first 3 sessions in hospital by standing against a wall with their feet 20 cm away from the wall ( TT ) for 10 minutes. Then TT was performed at home twice a day progressively increasing its duration up to 30 minutes. Home training lasted 30 days and was repeated twice at interval of 1 month. Head-up tilt test was reevaluated at 6 months and the clinical effect was noted over a mean follow-up period of 11 +/- 5.4 months.


Results - Compliance to TT was 90% ( 18/20 pts ). Positivity to 6 month head-up tilt test was 6.7% ( 1/15 ) with a 93.3 % reduction ( p < 0.01 before v after TT). Spontaneous syncope recurrence was 5% (1/20 pt ) with a 95% reduction ( p < 0.01 before v after TT)
No adverse events were observed during the home training.


Conclusions - Home self-TT is feasible, safe and effective in preventing recurrence of NMS in children and adolescents.