Double-Blind Sham-Controlled Crossover Trial of Repetitive Transcranial Magnetic Stimulation for Mal de Debarquement Syndrome

Abstract

Objective To determine whether the chronic rocking dizziness that occurs in mal de debarquement syndrome (MdDS) can be suppressed with repetitive transcranial magnetic stimulation (rTMS) beyond the treatment period. Methods We performed a prospective randomized double-blind sham controlled cross-over trial of five-days of rTMS utilizing high frequency (10Hz) stimulation over the left dorsolateral prefrontal cortex (DLPFC). Results Eight right-handed women (44.5 (sd 7.0) years) with classical motion-triggered MdDS (mean duration 42.1 (sd 13.2) months) participated. Group level mixed effects repeated measures ANOVA showed improvement in our primary outcome measure, the Dizziness Handicap Inventory (DHI) at Post TMS Weeks 1, 3, and 4 (p<0.05) and a trend at Week 2 (p=0.089) after Real rTMS. On the Hospital Anxiety and Depression Scale, improvements started at Post TMS Week 2 for the Anxiety subscore and Post TMS Week 3 for the Depression subscore after Real rTMS only (p<0.05). There were no group level improvements on the MdDS Balance Rating Scale after Real rTMS though there were three participants who improved on an individual level. There were no significant group level changes after Sham stimulation on any measure. Conclusion Our study provides evidence that the dizziness, mood and anxiety symptoms of MdDS can be improved with 10Hz rTMS over left DLPFC beyond the treatment period in selected individuals. rTMS may be a useful adjunctive treatment for the management of chronic rocking dizziness in individuals with MdDS but treatment durations longer than five days or maintenance treatment are likely needed for sustained symptom suppression.

Repetitive transcranial magnetic stimulation (rTMS) as a treatment for chronic dizziness following mild traumatic brain injury

“…A double-blind sham-controlled study of eight right-handed women with a history of classic motion-triggered Mal de Debarquement Syndrome used 10 Hz rTMS stimulation of the left DLPFC and found a significant improvement in dizziness, mood and anxiety symptoms 24. This study also used the DHI as a primary outcome measure for disability secondary to dizziness.…”

Letter to the Editor: comment and erratum to “Mal de debarquement syndrome: a systematic review”

“…However, this should not be taken to imply that there are no long-term effects from neuromodulation, nor should it be interpreted that vestibular ocular reflex (VOR) modulation [8], reported to have a long-term effect, is therefore superior to neuromodulation. Long term treatment effects of neuromodulation with rTMS and transcranial direct current stimulation have recently been reported [9,10]. Concerning the suggested diagnostic criteria, we want to make a note that the relation between MdDS and virtual reality (VR) as a trigger is still not clear.…”

Mal de Debarquement sindromas: klinikiniai atvejai ir literatūros apžvalga

“…Áro dy tas tei gia mas ðios te ra pi jos efek tas, ma þinant siû buo jan tá gal vos svai gi mà, ge ri nant nuo tai kà ir maþi nant ne ri mà. Il ga lai kiam simp to mø slo pi ni mui ga li bû ti rei ka lin gas il ges nis nei 5 die nø gy dy mas ar pa lai ko ma sis gy dy mas [9].…”

“…Yra duo menø apie neu ro mo du lia ci jos su rTMS (pa si kar to jan ti transkra nia li në mag ne ti në sti mu lia ci ja, angl. re pet i tive transcranial mag netic stim u la tion) ir transk ra niji nës nuo la ti nës sro vës sti mu lia ci jos il ga lai ká po vei ká (tDCS) [8,9]. Efekty vi yra pro fi lak ti në te ra pi ja an ti dep re san tais, an ti kon vulsan tais, kal cio ka na lo blo ka to riais.…”