Clinical features and associated syndromes of mal de debarquement

Abstract

Objective-To investigate the clinical features and natural history of mal de debarquement (MdD).Design-Retrospective case review with follow-up questionnaire and telephone interviews. Setting-University Neurotology Clinic.Patients-Patients seen between 1980 and 2006 who developed a persistent sensation of rocking or swaying for at least 3 days after exposure to passive motion.Main outcome measure-Clinical features, diagnostic testing, and questionnaire responses.Results-Of 64 patients (75 % women) identified with MdD, 34 completed follow-up questionnaires and interviews in 2006. Most patients had normal neurological exams, ENGs and brain MRIs. The average age of the first MdD episode was 39 ± 13 years. A total of 206 episodes were experienced by 64 patients. Of these, 104 episodes (51 %) lasted > 1 month; 18 %, > 1 year; 15 %, > 2 years; 12 %, > 4 years, and 11 %, > 5 years. Eighteen patients (28 %) subsequently developed spontaneous episodes of MdD-like symptoms after the initial MdD episode. There was a much higher rate of migraine in patients who went on to develop spontaneous episodes (73 %) than in those who did not (22 %). Subsequent episodes were longer than earlier ones in most patients who had multiple episodes. Re-exposure to passive motion temporarily decreased symptoms in most patients (66 %). Subjective intolerance to visual motion increased (10 % to 66 %) but self-motion sensitivity did not (37 % to 50 %) with onset of MdD.Conclusion-The majority of MdD episodes lasting longer than 3 days resolve in less than one year but the probability of resolution declines each year. Many patients experience multiple MdD episodes. Some patients develop spontaneous episodes after the initial motion-triggered episode with migraine being a risk factor.

Exploring the pathophysiology of Mal de Debarquement

“…ICF is generally thought to be mediated by excitatory glutamatergic interneurons and NMDA receptors [8], while SICI is mediated by GABA type A receptors [6]. Interestingly, the observation of increased ICF in our MdDS patient is consistent with the finding that patients with MdDS report a moderate improvement in symptoms with benzodiazepines [3], which mechanistically functions to reduce ICF [8].…”

Neuronal Mechanisms and the Treatment of Motion Sickness

“…This effect is called ‘mal de débarquement', ‘land sickness' or ‘adaptive aftereffect' [7,64]. These symptoms typically dissipate over several hours or days but can linger for weeks [65,66]. …”

Social, societal, and economic burden of mal de debarquement syndrome

“…Mal de debarquement syndrome (MdDS) is a balance disorder in which patients develop a persistent perception of phantom movement after a prolonged period of passive motion exposure (e.g., 'land-sickness' following an ocean cruise) [1][2][3]. In the vast majority of patients, the perception of phantom motions disappears relatively quickly after returning to stable ground (e.g., minutes to days); however, in rare instances the symptoms may persist for months to years (persistent MdDS) [1,2].…”

“…In the vast majority of patients, the perception of phantom motions disappears relatively quickly after returning to stable ground (e.g., minutes to days); however, in rare instances the symptoms may persist for months to years (persistent MdDS) [1,2]. Individuals with persistent MdDS describe a sense of movement such as ''rocking'' and ''bobbing'' even though they are not physically moving [1,2].…”