Readaptation of the Vestibulo-Ocular Reflex Relieves the Mal De Debarquement Syndrome

Abstract

The mal de debarquement syndrome (MdDS), a continuous feeling of swaying, rocking, and/or bobbing, generally follows travel on the sea. The associated symptoms cause considerable distress. The underlying neural mechanisms are unknown, and to date there have been no effective treatments for this condition. Results in monkeys and humans suggested that MdDS was caused by maladaptation of the vestibulo-ocular reflex (VOR) to roll of the head during rotation. We studied 24 subjects with persistent MdDS (3 males, 21 females; 19.1 ± 33 months). Physical findings included body oscillation at 0.2 Hz, oscillating vertical nystagmus when the head was rolled from side-to-side in darkness, and unilateral rotation during the Fukuda stepping test. We posited that the maladapted rocking and the physical symptoms could be diminished or extinguished by readapting the VOR. Subjects were treated by rolling the head from side-to-side while watching a rotating full-field visual stimulus. Seventeen of the 24 subjects had a complete or substantial recovery on average for approximately 1 year. Six were initially better, but the symptoms recurred. One subject did not respond to treatment. Thus, readaptation of the VOR has led to a cure or substantial improvement in 70% of the subjects with MdDS. We conclude that the adaptive processes associated with roll-while-rotating are responsible for producing MdDS, and that the symptoms can be reduced or resolved by readapting the VOR.

Treatment of the Mal de Debarquement Syndrome: A 1-Year Follow-up

“…Thus, the treatment we developed is reproducible (1). If the reversion problem can be resolved, more than 75% of MdDS patients will benefit from this treatment.…”

Effect of Developmental Binocular Vision Abnormalities on Visual Vertigo Symptoms and Treatment Outcome

“…10 Optokinetic stimulation induces adaptation of specific vestibular parameters, including postrotational vestibular sensation and vestibular ocular reflex gain in primates, people with chronic peripheral vestibular disorders, and healthy individuals. 56−59 Significant improvements have also been noted in optokinetic nystagmus, 60 and/or postural stability, 60,61 after treatment with optokinetic stimulation in people with peripheral vestibular disorders or mal de debarquement syndrome. Treatment with graded exposure to optokinetic stimuli aims to habituate and desensitize to visual motion and promote a more effective use of vestibulo-proprioceptive cues through sensory reweighting.…”

Dedication to Mingjia Dai, Ph.D. for Discovery of the First Successful Treatment of the Mal de Debarquement Syndrome

“…With the Dai et al treatment, there was an immediate improvement rate of 75%, in 17 of 24 patients (17). This treatment also relieved the motion sickness susceptibility of these subjects, predominantly women (18).…”

“…Of note, the primary findings were in the body and limbs and not in the eyes in the Vestibulo-Ocular Reflex (VOR), and there was only rarely spontaneous nystagmus in these patients. This series of maneuvers is described in detail in a publication (of which Dai was the first author) in 2014 (17).…”