Comprehensive Clinical Profile of Mal De Debarquement Syndrome

Abstract

BackgroundThere has been increasing awareness that post-motion triggered rocking self-vertigo can last for months or years, a disorder known as Mal de Debarquement Syndrome (MdDS). A similar feeling of oscillating self-motion can occur without a motion trigger in some individuals, leading to controversy about whether motion triggered (MT) and non-motion triggered (non-MT) symptoms ultimately represent the same disorder. Recognizing the similarities and differences between MT and non-MT MdDS can prevent unnecessary diagnostic testing and lead to earlier and more effective treatments.MethodsStandardized questionnaire assessment and follow-up interviews of individuals with persistent MT or non-MT MdDS (>1 month) examined at a University Dizziness Clinic.FindingsQuestionnaires were available on 80 individuals with persistent MT MdDS and 42 with non-MT MdDS. Sex distribution (81% female) and age of onset (mean 43.4 ± 12.2 years MT; 42.1 ± 15.2 years non-MT) were comparable between MT and non-MT MdDS (p > 0.05). Mean duration of illness was significantly longer in the non-MT group (82.8 ± 64.2 months) than the MT group (35.4 ± 46.4 months) (p < 0.001). There was no correlation between trigger type and age of onset or duration of illness for MT MdDS. Improvement with re-exposure to motion (driving) was typical for both (MT = 89%, non-MT = 64%), but non-MT individuals more frequently had symptoms exacerbated with motion (MT = 0%; non-MT = 10%). Peri-menstrual and menstrual worsening of symptoms was typical in both MT and non-MT MdDS (each 71%). Both MT and non-MT MdDS exhibited a higher population baseline prevalence of migraine (23% and 38%, respectively). Benzodiazepines and SSRI/SNRIs were helpful in both subtypes of MdDS (>50% individuals with a positive response). Physical therapy was modestly helpful in the MT (56%) subtype but not in non-MT (15%). Vestibular therapy made as many individuals worse as better in MT and none improved in the non-MT group.ConclusionGeneral demographic characteristics and exacerbating factors are similar in MT and non-MT MdDS, but there are differences in the duration of illness, effect of motion on symptoms, and response to therapy. Recognizing clinical features of MdDS subtypes may allow for better tailoring of therapy and potentially serve as classification criteria for new clinical designations.

Mal de Debarquement Syndrome

“…Despite the term "spontaneous" used in some references, there is typically a trigger such as an episode of true rotational vertigo, severe emotional stress, a medical illness, or a physiological derangement such as hormonal shifts or acute medication changes. 13 It is strikingly similar to MdDS in that the predominant sensation is an oscillating motion that often improves or remits with reexposure to passive motion, such as driving. 11,13 Misdiagnosis appears to be more common in non-MT oscillating vertigo, as the typical history in relation to triggers is not present.…”

“…13 It is strikingly similar to MdDS in that the predominant sensation is an oscillating motion that often improves or remits with reexposure to passive motion, such as driving. 11,13 Misdiagnosis appears to be more common in non-MT oscillating vertigo, as the typical history in relation to triggers is not present. Such patients are often incorrectly given nonspecific "vertigo" or "anxiety" as a diagnosis.…”

“…19 However, PPPD is by definition worsened with active or passive movement, whereas "non-MT MdDS," or "spontaneous MdDS," is usually improved with passive motion. 13 It should be clear, however, that none of the terminology used to describe this non-MT persistent oscillating vertigo is semantically correct because by definition MdDS is triggered by motion.…”

“…Recognizing this subtype is important because they do response to antidepressants and benzodiazepines similar to MT MdDS. 13,18 The similarities are likely pathophysiologically linked to MdDS because a subset of these individuals have had a prior episode of typical MT MdDS that resolved but recurred without a subsequent motion trigger. 11…”

“…The persistent oscillation in MdDS is present in all body positions, and only improves or remits when the individual is reexposed to passive motion such as driving a car or getting back on a boat. 5,13 A general neurologic examination in MdDS patients is usually normal. 11,14 However, some studies report that MdDS patients will have mild vestibular imbalance manifested by turning during the Fukuda stepping test (aka the Unterberger test).…”