Tilt training: a new challenge in the treatment of neurally mediated syncope.

Clinical experience with repeated tilt testing and standing training has shown that this procedure can be used as a new therapy for the restoration of abnormal autonomic orthostatic reflexes. The introduction of tilt training therapy for neurally mediated syncope is a new and effective treatment. This new therapy has been used recently in several centres with excellent results. Since syncope is a severe social handicap for the patient, successful therapy will normalise the functional status and restore self-confidence. The use of tilt training can be considered as first-line therapy in this disorder. In the majority of the studies on tilt training, patients remain free of syncope during active treatment with this therapy. In about 50% of the patients with neurally mediated syncope already the second consecutive tilt test became negative. This therapeutic effect of in-hospital repeated tilt tests is sustained by continued standing training at home.