Talk:Reflex syncope

Expansion of page + Link to Chronic Fatigue Syndrome

If anyone wants to assist, I think this page could use some upkeep and expansion. As it stands right now this page is somewhat messy and missing some highly relevant information.

Here is a link to a highly informative online article on Orthostatic intolerance, in particular Neurally Mediated Hypotension (NMH, aka neurocardiogenic syncope), the condition most associated with vasovagal syncope.

This article needs more clarification of its connection to conditions such as NMH and to orthostatic intolerance in general.

Also, the treatment section should be updated, such as to mention the importance of increased salt and water consumption in fending off syncopal episodes.

Another topic worth mentioning, is the link between NMH (which can manifest as vasovagal syncope) and Chronic Fatigue Syndrome (CFS). This link is well documented in several peer reviewed journal articles (citations can be found here). It is also mentioned in an informative emedicine.com article on orthostatic intolerance, which will be valuable for updating this article (along with the wikipedia article on Orthostatic Intolerance). Here are a few other links discussing the connection between NMH (or vasovagal syncope) and CFS: [1] [2].

So, I propose that changes to this page and the Orthostatic Intolerance page should be made and be coordinated. Furthermore, these pages should be expanded and organized to give a clear definition of the relation of vaso-vagal syncope to conditions of orthostatic intolerance, to include the name(s) of the conditions which are associated with vaso-vagal syncope, and to include more information on treatment and the link to CFS.

One other question is whether these conditions should still be subsumed under the article vaso-vagal syncope, considering that vaso-vagal syncope is generally caused by the condition neurally mediated hypotension, yet NMH does not always result in syncope.

-- 19:59, 9 November 2006 (UTC)

I'm removing the following sentence: "It is worth noting that on rare occasions, a fainter may die if forced to remain upright." Does anyone have a citation or study for this outcome? — Knowledge Seeker দ 06:03, 19 Apr 2005 (UTC)

As a sufferer i was given that exact advice from my doctor, if i am not allowed to sit or fall during a fit the blood loss to the brain can be fatal. --Seth Turner 10:44, 3 February 2006 (UTC)

I am also chronic sufferer (I "black out" from an episode 5-10 times a week). While being diagnosed, my cardiologist instructed me to lay down in order for my body to restore blood-flow, but when I black out these days (My condition showed itself when I was 5, I am now 19), if it is not practical to lay down, I don't. I can remain upright for a black-out via learned a learned behavior ("rocking" in a circular motion while standing). I haven't noticed anything negative about this, although I am not a medical doctor. I can't rule out the mentioned "rare occasions" though.--SirGrok 07:52, 12 April 2007 (UTC)

• Wow, I can't believe that I haven't looked at this talk page before now, or I would have answered this a long time ago. I have vasovagal syncope and I was told that by my former doctor (though I wasn't the one who originally put that in the article). The idea is, if there's low blood pressure and what little blood volume there is is pooling in the legs, then that means there won't be enough blood in the brain, and the brain will become starved for oxygen and other nutrients. Jacqui ^★ 04:08, 10 November 2005 (UTC)

There does not need to be a study of death by inappropriate treatment documented many thousands of years ago and regrettably in more than one coroners report.

Actualy its more like seeing static than blurry vision. Like the snow screen you get when your telivision isnt tuned in. Baiscaly for me its total blindness during the syncope.--Seth Turner 10:44, 3 February 2006 (UTC)

There does need to be a citation for a comment like that. It doesn't have to be a randomized clinical trial. It could be a reference from a medical textbook. I personally think there is far more danger from being allowed to fall down and hit your head on the pavement. Yes, your blood pressure drops during vasovagal syncope, and yes, you should gently lie the patient down to a supine position. But death? From holding a vasovagal syncope upright? Sounds like mythology to me, but I'm willing to be proven wrong. MoodyGroove 19:29, 25 January 2007 (UTC)MoodyGroove

You're looking for Suspension trauma -- Falling down increases blood flow to the brain. If the person remains upright -- usually because they are trapped in a harness -- they may not be able to restore blood flow to the brain, and they could die. Moving your legs causes a pumping action that prevents blood from pooling in the legs. --Mdwyer 16:54, 10 April 2007 (UTC)

I am 53 years old and reasonably fit non smoker etc. I was recently diagnosed with vasovagal syncope brought on by dehydration amongst other things. During Tilt Table Testing my heart stopped for 21 seconds before being revived by medical means. I now have a pacemaker fitted to guarantee a minimal pulse rate of 50 bpm. It operates mostly around 3-4 am when statistically more people die in their sleep (circadien rythm ?). So I now beleive VVS can be a killer. Ian Roberts

--- Only have time to quickly note a slightly different situation described by Ian (heart stopping) vs. the above discussion re: 'dying from remaining upright' during vasovagal response. I only mention it because your heart stopping is clearly rather bad for you (I have had this happen to patients from vagal response to peritoneal stretching; other classics are eye surgery etc), whereas the poor perfusion while upright is in somewhat of a different range of urgency! I wish I had time to search for data, but - if it helps - it appears to be somewhat counter-intuitive to be able to keep oneself upright for long enough to cause death, despite proprioception etc being controlled at a low/basic level. Whilst I would imagine nothing is impossible, I could only think that one would have to be kept passively upright (a harness was mentioned, although these typically seem to keep one in a semi-crouched position, and the head would drop) to force a situation resembling the described danger. The crucial difference would be that normally there is a slight delay between a sudden blood pressure change (standing quickly, vagal storm or whatever), and the baroceptors noticing & feeding back instructions to increase perfusion via increased stroke volume, higher heart rate, increased peripheral resistance etc; a very brief delay is not uncommon in everyday people (sometimes perceptible), whereas people with such a propensity might have a longer delay (slower restoration of perfusion). This is still a delay however (otherwise you would expire; you would never be able to stand under any circumstances), although it may cause temporary loss of consciousness. The difference in the proposition of death by remaining upright, is that there is no temporary relief during this intervening period of poor perfusion, by your head (and body) falling to a lower level (syncope); however, one would also have to assume that the expected response (physiological restoration of blood pressure) would somehow either then be absent, or that the delay was extremely long (cerebral ischaemia causing permanent damage typically reported as e.g. 3 minutes onward). Much like aviation, one could postulate that several problems might well have to occur simultaneously for this to have any likelihood of an effect! (i.e. when one considers serious co-morbities, then any cause of a transient hypotension might have a knock-on effect - or a slower return to homeostasis). As a separate issue, complete asystole - as described by Ian Roberts - is incompatible with life, and being in any position including (passively!) upright, upside down or whatever is irrelevant to your blood, which would be static! Returning to the proposed mechanism, however, when one considers the risks from simply falling during syncope - which are very real - the possiblity of being able to remain upright and then have no physiological response to a critical lack of perfusion seems very remote. Having said that - as any infant intuitively knows - it is clearly good common sense to sit or lie immediately when one feels faint (for any reason)!

Stepping outside of scientific consideration, the idea of dying whilst standing upright (for this reason) sounds suspiciously like an urban myth; however, I don't want to dismiss something out of hand without any evidence! By that same measure, to include such a proposal in Wikipedia (which informs both the general public, and is even 'trusted' by some healthcare students nowadays) is an exceptional claim, and would require very clear (i.e. exceptional) evidence, lest we simply spread 'what we heard somewhere' into an internet 'what I read somewhere'.... This, of course, is entirely separate from the rather obvious advice to not remain standing when you feel faint!

Please don't interpret this as a medical opinion - I am not qualified, allowed, nor would be able to give such advice even if I was silly enough to try! If you suffer from a related problem, talk to your doctor about your concerns; hopefully they will be as interested in the idea as I am! Shane Wilde (clinician & medical student).

Perhaps we should include some information about Suspension trauma in this article, then. Would you like to add it? WhatamIdoing (talk) 23:21, 12 March 2009 (UTC)

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I've had VVS for about 20 years (will be 33 in 28 days or so) normal mild episodes occur after kneeling of sitting cross-legged then standing quickly and happen for about 2-5 seconds (feels like 2-5 minutes). I recently had 2 very bad episodes with total blackouts taking 15 - 20 minutes to recover from and lasting between 2 and 5 minutes before recovery starts). I broke my leg 3 months ago and have been spending most of my time lying down since then. I have just started doing workouts with weight machines at my Physical Therapist appointments an two visits in a row I completely blacked out. The episodes start with a tightness in the chest, similar to a heart attack, as the heart starts having problems pumping the blood around the body (pooling in the legs, which I also have large quantities of varicose veins around my ankles), then you start to feel like you aren't breathing even though you are (similar to an asthma attack), followed by light-headedness. At this point it is like the really old CRT TV's and Monitors, everything starts to look like the snow on the tv (I never thought of it like that till I read this page), kind of speckled between what is real and darkness and like the computer monitor, it slowly fades out into darkness in a pulsing manner (with your heart beat, where after each beat it is brighter, then fades further in to darkness right after). If I am still standing at this point I start to fall over (similar to falling asleep in school, when your head starts nodding), most times this is enough to drive my consciousness to try and force my body to "wake up" giving me a brief second or 1.5 seconds of cognition to attempt to lay down or find support to lean on before it is lights out. My PT suggested that I might have VVS an has directed me to a neurologist and a cardiologist to check for VVS and Orthostatic Hypotension. She said that what occurs is with my increased heart rate and decreased blood pressure that the valves in my veins are either not constricting completely or are not reacting fast enough and the blood follows gravity with more efficiency than the valves are able to counter-act. I had not heard of it before, but had been having this happen, as I mentioned above, for about 20 years maybe longer, I used to think it was cool and would do it on purpose to freak people out, or while alone because I thought it felt "neat", no I never did drugs and I drink about 2-4 beers ever 3-8 months; although I drank massive amounts of whiskey for 3.5 years while in college. I hope this helps, might want to check with some cardio and neural specialists on this, or even some physical therapists, 3 of the PTs in the office I was at were familiar with OSH and its symptoms and treatments and one had familiarity with VVS. (Finndo (talk) 13:48, 16 April 2010 (UTC))

Ginger Ale?

How would ginger ale help? I haven't done any research outside of reading that line, but as far as I know, modern day ginger ale is no different from any other soda in terms of ingredients.

That entire line seems somewhat spurious, regardless, as the end of the sentence directly before it clearly mentions increasing fluid and salt intake. Plus there's a comma splice! Yuck. I'll clean it up a bit. - Zowch 09:02, 28 May 2006 (UTC)

When I was on active treatment, I was ordered to drink .5 gallons of Gatorade (or any other electrolyte heavy fluid a day). This was for the sodium and the electrolytes. I was also taking 1gm of sodium by tablet a day (in addition to eating a salt heavy diet) and Flourinef (I do not remember the dosage... I was probably 100 lbs at the time of the treatment). I have never heard about ginger ale being a home-remedy. --SirGrok 19:26, 30 May 2007 (UTC)

Contradiction??

"Vasovagal syncope (also vasodepressor syncope ...[truncated]... It is important to realize that vasovagal syncope and vasodepressor syncope are NOT the same." (Quoted from the version on 8/10/2006.)

This is a contradiction. Either vasovagal syncope is also known as vasodepressor syncope or they are not the same. Someone with medical expertise, please clairfy. Jxyama 17:37, 10 August 2006 (UTC)

Yeah, that looks like a mess. I am not a doctor; I have the condition. None of my doctors have used the term vasodepressor syncope on me, though. Nevertheless, a quick look at the web in Google shows a few places where the terms appear to be used interchangably: This one includes two more names for the condition? This one lists a cause I've never heard of?

LIS, I'm not a doctor, and frankly I know this diagnosis is somewhat controversial. It was only "discovered" five to ten years back and I think they are still working out what is and isn't part of this diagnosis. Anyway, I'm going to add the expert tag and do nothing else for now. Jacqui^★ 13:44, 19 August 2006 (UTC)

Just a touch of input. I have Vasodepressor Syncope, as was directly diagnosed, and a few things seem to be quite different between that and the vasovagal condition described above. In my case (I was told it is a typical case)The heartrate skyrockets(upwards of 200 bpm at rest) and bloodpressure drops(somewhere into the low 20's). This results in a pooling of blood in the feet, and a lack of blood in the brain. As far as I understand, VDS is actually heart-initiated, where VVS is initiated by a lack of blood in the core of the body. Same results, different reasons. Understand that this is simply an explanation from one doctor to a patient, and conformation would be reccomended. -Jason

Note: the IP address that added the disputed section has many vandalization messages on its talk page. Nevertheless, IPs can be shared by many people and so we should still look into this carefully. Jacqui^★ 13:49, 19 August 2006 (UTC)

Vasovagal syncope, vasodepressor syncope, neurocardiogenic syncope, and situational syncope all refer to the same form of syncope.(http://www.medterms.com/script/main/art.asp?articlekey=7713) I believe neurally-mediate syncope is also synonymous.

—Preceding unsigned comment added by 222.124.68.252 (talk) 05:32, 2 October 2007 (UTC)

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Prognosis

I removed from the article the sentance, "It may also be associated with certain psychiactric disorders." There's no citation for this. Is this true? And if it is, what psychiatric disorders are associated? --Brokenchairs (talk) 14:56, 19 January 2008 (UTC)

Last time i was told by ER techs, it can be caused by Anxiety 172.189.6.182 (talk) 07:29, 29 January 2008 (UTC)

I was just diagnosed with vvs today, for me these episodes occur only when I smoke pot. I do not think that the cause of these episodes are due directly from this drug but during the time, my consiousness is altered as anyone who smokes should know, and I become super sensitive to things. The first two times it happened i was in the shower and it was really steamy in the room and i felt like i was suffocating..the other time i was watching pulp fiction and got really anxious due to the scenes in the movie. My fainting episodes usuallys start with me feeling dizzy and overwhelmed becuase I feel like i can't breathe. Then things become blurry and I "fade" out and then I pass out. My doc told me to just make sure I lie down when I feel the oncoming of any episode and to increase blood circ. to my brain. Also, I am a stylist so I am on my feet all day, and then I exercise 5 days a week after work...but although I consider myself pretty healthy, I know that I do not drink enough water and I do smoke cigarettes which causes dehydration, and with the addition of pot... I think that it is the ultimate dehydration and THAT is why I have my episodes. Does anyone know anything about marijauna users and vvs?BAM721 (talk) 16:45, 11 March 2008 (UTC)BAM721

Being complicated

Instead of saying 'sayone faints', would 'someone Vasovagal syncopes' make sense just to be complicated to people? 86.135.42.213 (talk) 14:48, 20 April 2008 (UTC)

Triggers

I have always been a sufferer of vasovagal syncope, triggered by medical procedures. Most often, it is receiving injections.. I'll be fine during the injection, but within 5 minutes I lose blood pressure and start feeling very queasy, to the point of fainting. Sometimes, it takes merely thinking about medical procedures to trigger the effect. Once, I was at a friend's apartment and he was flipping through TV channels, and came across a liposuction procedure on Discovery.. Very harsh and painful looking procedure, it makes me feel uncomfortable even thinking about it as I type this.. But I had to ask him to change the channel because I felt like I was going to faint.

I suffer from vasovagal syncope during injections as well. Last night, I suffered one after watching a very realistic dramatization of phlebectomy. I have no problem watching extremely gory and violent films, but in this case, because the situation was made to be as realistic and matter-of-fact as possible, it brought back memories of being hospitalized during the influenza outbreak of 1962 (at the age of 2), and down I went.

..My point is, this is my personal experience based anecdotal citation for adding the "viewing/experiencing medical procedures" to the Triggers section. Weasel5i2 (talk) 08:53, 5 May 2008 (UTC)

I don't see a reference to alcohol as either a trigger or at least a contributor. I am an occasional sufferer and when I discussed it with my doctor he immediately asked about alcohol consumption, which was a common factor in my case, and said that it was a "usual" factor (his term) in a vasovagal episode. If anyone can cite this I suggest it would be a useful addition. Delverie (talk) 18:10, 26 July 2009 (UTC)

Including the mammalian diving reflex hyperlink as a potential cause is wrong. the mammalian diving reflex causes bradycardia and vasoconstriction, whereas vasovagal syncope causes bradycardia and vasodilation. I'm not going to remove it, because I lack the authority. 22/05/2011 —Preceding unsigned comment added by 87.113.215.177 (talk) 22:07, 22 May 2011 (UTC)

Beta blockers

Are beta blockers still used for Postural orthostatic tachycardia syndrome, which also involves vasovagal syncope? WhatamIdoing (talk) 17:01, 28 July 2008 (UTC)

New source

The British Medical Journal has a good overview (free) on this topic here. It might be useful for cleaning up some of this article and/or sourcing some of the parts that already exist and are correct. WhatamIdoing (talk) 04:47, 3 February 2009 (UTC)

Vasodepressor syncope management by sufferer

Nellbednarz (talk) 16:18, 8 January 2010 (UTC) I am in my 50s and have suffered with vasodepressor syncope all my life. I was misdiagnosed with hypoglycemia in 1981 and lived on a no-sugar diet for many years. That did help, because sugar acidifies the blood and makes calcium dump out of your system (as does caffeine, phosphoric acid from soft drinks, and hyper-ventilating since too much O2 acidifies the blood), and causes blood to pool in the legs. My daughter began showing symptoms while in elementary school, sometimes being so severe that we thought she was having a heart attack. The doctor that diagnosed her from her symptoms was the head of pediatric cardiology in Texas Children's Hospital in Houston, Tx. While he was explaining that this is a disorder that is congenital (genetic) and tied to mitral valve prolapse, my daughter turned to me and said "This is what makes you so faint sometimes".

I was diagnosed by a Tilt Table Test at Houston Arrythmia Center in 2006, with a textbook reaction and fainting. My blood pressure soared to 160/100, triggering a delayed but profound reaction of my brain telling the adrenal glands to dump a lot of adrenal to lower the blood pressure, which caused the blood pressure to drop so low that it could not be measured. Those of us with this disorder often have problems with anxiety because we are pumping a lot of adrenaline on a daily basis. This can lead to adrenal exhaustion.

Vasovagal syncope can happen to almost anyone, vasodepressor syncope happens in families and is usually life-long, since it is linked to the gene that causes mitral valve prolapse (according to Dr. Timothy Bricker). Years ago, I concentrated on how I could help my daughter have a more normal life. She was struggling to have enough energy to make it through a day at school (the dehydration capital of the world). It seemed that calcium/electrolyte dumping was a major problem for both of us, resulting in extreme hot flashes then diarrhea. The trigger was usually food-related, and we found that eating sugar or having caffeine from chocolate or coffee was the common cause. Drinking 1/2 of a coffee-based drink put my daughter in the hospital ER, and she was told never ever to have coffee or caffeine. Our medical bill for that episode is still very convincing. Caffeine causes blood to pool in the legs, as does sugar, starving the heart, which will exert a lot of pressure on your right arm to get more blood. It hurts to the point of disabling you.

As a trained scientist, I naturally wanted to find answers for our sudden fatique problems. In digging to find a way to stabilize the calcium in our systems, I read Dr. Robert Atkins "Vita-Nutrient Solution" about how different nutrients work, usually needing a balance to keep us healthy. Vasodepressor syncope is not discussed in that book, but the balance of electrolytes (which is crucial in our living healthy lives) is covered very well. The amino acids are covered, and while reading about the functions of taurine, I made an important discovery.

Taurine is not the muscle-building type of amino acid; it primarily functions in maintaining calcium, magnesium and other electrolytes where they belong, rather than letting the minerals go where they do not belong. Taurine stabilizes pressure in the eye, controls the viscosity of bile and other fluids, and even acts as a diuretic only if you have too much water in your body compared to electrolytes.

I decided that we would try using taurine to keep our calcium from dumping. In the years since my discovery (2006), practice has taught me this -- I need to take 1000 mg. of taurine with each meal and before exercise about 3000 mg per day but can go up to 5000 mg/day in 1000 mg doses), as well as massive supplementation of magnesium, calcium, zinc, manganese, and other minerals, keeping proportions balanced. This is therapeutic doses as described by Dr. Atkins. Magnesium is often the limiting factor. Without enough magnesium, you will feel chronically dehydrated and suffer muscle cramps.

Supplementation of the B vitamin complex is also essential to dampen the anxiety response. I find that I need sublingual B-12 every day to keep up my energy, and that B-12 pills only give you 2% of the vitamin whereas sublingual (under-the-tongue application held 30 seconds) gives you about 98% of the vitamin. I learned that anything with too much sugar caused problems, including Gatorade, so my practice is to carry salt packets with me in case of a major muscle cramp (especially the heart or lungs) and drink plenty of water. To balance the potassium and sodium intake, it is important to use "salt substitute" (potassium salts) on food, which gives about 17% of the daily need.

Avoiding sugar can be a struggle, and sugar substitutes can cause bowel problems. Fructose seems to be tolerated better and not cause so much calcium dumping, but my current favorite sweetener is Stevia (Truvia is a current brand). Recipes for stevia can be found online. Bananas and grapes have too much sugar, but berries and low-sugar fruits are the ideal dessert.

I give this advice as a sufferer of vasodepressor syncope, not as an MD. I have found that most doctors don't know much about this disorder, and I have been my own guinea pig. Before I began working out this nutrient thing, I would have such severe muscle cramps that I would be bedridden for days. Now I rarely ever have to do more than rest with my feet up. The blood vessels in my legs don't break nearly as much as they once did and life is much more normal, but I still eat often (every 2 hours or so a small healthy snack like nuts), drink plenty of water all day, stay away from heat or heavy excerise, walk every day if possible (walking pumps the blood back to the heart), and take my nutrients throughout the day at meals, according to what is balanced. A doctor or nutritionist would help with this.

Of course, I try to stay calm and learned bio-feedback to help me with chronic anxiety. As a Believer in the Lord, I have found that turning my worries over to Him helps me stay focused and steady.

Please take time to have yourself tested with the Tilt Table Test, and have guidance in what you do. Taurine naturally lowers the blood pressure, so testing BP at waking will let you know if you really need blood pressure meds or not. Always tell your doctor if you are taking supplements to lower blood pressure. From NB in Texas Nellbednarz (talk) 16:18, 8 January 2010 (UTC)

Need an expert in Wiki syntax to fix References problem

I could not figure out how to fix: References

  1. ^ vasovagal attack      
     at Dorland's Medical Dictionary will not affect my baby girl kaitlin.

I searched for "kaitlin" in the edit view of the page, and nothing came up. I'm sorry I can't do more, but I'm chronically ill so most days I can only do quick fixes, meaning sometimes I can only point out the problem and hope someone else will fix it. Thanks! —Preceding unsigned comment added by Geekdiva (talk • contribs) 05:01, 29 March 2010 (UTC)

no "will not affect my baby girl kaitlin" nonsense in currentversion - suggest refresh your page view. David Ruben ^Talk 20:40, 4 April 2010 (UTC)

Merge vagus reflex

Vagus reflex currently covers same topic and is a mere stub to this article, listing just a limited selection of causes. David Ruben ^Talk 20:37, 4 April 2010 (UTC)

Rename to vasovagal response

The following discussion is an archived discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the move request was: page moved.  Ronhjones  ^(Talk) 01:02, 13 April 2010 (UTC)

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Vasovagal episode → Vasovagal response — PubMed for "Vasovagal episode" =23 articles,"Vasovagal response" =64, "vasovagal attack" =18.

This article is on the physiological process, rather than being the extreme of fainting that may not occur. Hence "neurocardiogenic syncope" with 355 PubMed articles, is not an appropriate name (would be akin calling [neck sprain] by term [decapitation]). Likewise ICD10 code of R77 points to "Syncope and collapse" which is too general a process, of which this is but one cause.

Therefore, on basis of WP:MEDMOS "The article title should be the scientific or recognised medical name that is most commonly used...", I propose rename article to "Vasovagal response". David Ruben ^Talk 21:08, 4 April 2010 (UTC)

The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

aftermath/resolution

The article needs detailed and extensive information about immediate and lingering after-effects. What is the mechanism of recovery from vvr? What makes it faster or slower? How long can there be subtle after-effects (such as lower than normal heartrate): hours? days? weeks? -71.174.188.137 (talk) 03:38, 11 May 2010 (UTC)

Treatment Drugs

I am a 61-year-old man. I suffered my first episode of Vasovagal Syncope at age 4 or 5 when I cut my fingers playing with some discarded razor blades. My triggers continue to be blood related, including injections and blood draws, but it has also been triggered by painful injuries and most recently by food poisoning. When I was 33 years old a heart doctor threatened to install a pacemaker to remedy the problem. As an alternative he offered a prescription for an anticholinergic drug, Darbid. This is basically an ulcer medication. The drug worked, and I was episode free for many years. Darbid became unavailable and I was switched to Robinul Forte. Eventually I became accustomed to the stimuli and I did not need the drug. However, after being episode free without the drugs for about 8 or 9 years, I had another episode as a result of food poisoning. I now take the Robinul Forte again. My purpose in sharing this is to suggest to others, and the medical community, that perhaps anticholinergic drugs can help this problem for others without any significant side effects. 98.189.27.157 (talk) 21:25, 4 November 2010 (UTC)