THE USE OF METHYLPHENIDATE IN THE TREATMENT OF REFRACTORY NEUROCARDIOGENIC SYNCOPE

Recurrent neurocardiogenically mediated episodes of hypotension and br adycardia are a common cause of recurrent syncope that can be identifi ed by head upright tilt table testing. While the use of beta-blockers, theophylline, fludrocortisone, disopyramide, and serotonin re-uptake inhibitors can be helpful in preventing further episodes, some patient s are unresponsive to or poorly tolerant of these agents. We investiga ted the use of the central nervous system stimulant and peripheral vas oconstrictor methylphenidate in preventing both tilt induced and spont aneous neurocardiogenic syncope. Seven patients (all women, mean age 3 2 +/- 15 years) with recurrent syncope and positive head upright tilt induced hypotension/bradycardia (refractory to normal therapy) were pl aced on methylphenidate 10 mg orally three times per day. Six of the s even patients became both tilt negative and clinically asymptomatic ov er a 7-month follow-up period. We conclude that methylphenidate may be an effective therapy in patients with recurrent neurocardiogenic sync ope refractory to other forms of therapy.