Transcranial Magnetic Stimulation as Treatment for Mal de Debarquement Syndrome: Case Report and Literature Review

Abstract

This manuscript presents the case of an adult, male patient with mal de debarquement syndrome (MdDS); results from his experimental treatment with repetitive transcranial magnetic stimulation (rTMS) are also provided. Additionally, we included a review of literature related to the neurophysiology of MdDS and its treatment with rTMS. A 41-year-old man had been experiencing symptoms of MdDS, which initially emerged following a car ride, for 11 to 12 years. Pharmacologic approaches had failed to provide symptom relief; thus, we investigated an intervention using low-frequency (1 Hz) rTMS unilaterally for 2 consecutive weeks. The outcome measures included a standardized, computerized dynamic posturography test to quantify the patient’s balance and identify abnormalities in his use of the sensory systems contributing to postural control, as well as the Hospital Anxiety and Depression Scale (HADS) to measure his anxiety and depression. An rTMS treatment log was created to document any adverse events. Following rTMS, the patient’s balance scores improved significantly; these improvements were mostly related to the patient’s increased reliance on the visual and vestibular systems. Our patient’s HADS Anxiety and Depression subscores also showed improvement post-rTMS. The presented case study provides preliminary evidence that rTMS may be a noninvasive treatment option for improving balance, specifically in individuals with MdDS. This evidence can be used to further therapeutic research on, and provide strategies for treating, MdDS.

Treatment Options in Mal de Débarquement Syndrome: A Scoping Review

“…Improvements in balance and activities of daily living were also observed by an alternative protocol proposed in 2015 by Pearce et al (40), using high-frequency DLPFC twice per week for 4 weeks. Buard et al (41) also found sustained improvement in both sensory organization testing and the Hospital Anxiety and Depression Scale at 6 weeks using a unilateral low-frequency DLPFC. With regard to neurological monitoring of treatment responses, Ding et al (35) demonstrated that electroencephalogram (EEG) findings correlate with symptoms when performing DLPFC rTMS, later reaffirmed by others (42,43), and treatment success is optimized when coupled with EEG (44).…”

“…As with VOR rehabilitation, neuromodulating stimulation is a therapeutic option believed to provide symptom relief by modulating these aberrant neural connections, specifically via induction of an electromagnetic current in the underlying brain structures through an electromagnetic coil placed over the subject's scalp (34,41). Through functional neuroimaging studies, hypermetabolism in the left entorhinal cortex and hypometabolism in the left DLPFC were identified in subjects with MdDS (13).…”

Frequency-Dependent Reduction of Cybersickness in Virtual Reality by Transcranial Oscillatory Stimulation of the Vestibular Cortex

“…NiBS techniques are increasingly being used as therapeutic procedures as an alternative or complementary to traditional pharmacological therapies for many neurological and psychiatric disorders, capitalising on the long lasting, predictable and safe [34,40] after-effects of the stimulation interventions [41]. Among these, only a handful of previous pilot studies have used NiBS techniques to reduce vestibular symptoms of motion sickness or kinetosis: repetitive transcranial magnetic stimulation (rTMS) of the prefrontal cortex in cases of mal de debarquement syndrome [17,42] and anodal transcranial direct current stimulation (tDCS) of the right temporoparietal junction applied before a VR rollercoaster game [43]: in this study, anodal tDCS improved the oculomotor but not the nausea sub-score of the Simulator Sickness Questionnaire after the VR experience, but no data are reported on online changes in nausea or other physiological assessment parameters, nor it is known whether online tDCS could have improved CS (or not).…”

“…The rationale for using rTMS or tDCS to reduce vestibular symptoms is thought to be based on the induction of predictable changes in excitability [albeit via different mechanisms of stimulation-neural interaction of the two techniques [44] in the targeted cortical regions [42,43]. In the current study, tACS was preferred due to its unique ability to interact with endogenous oscillatory activity [40,44,45].…”

Mal de Debarquement Sendromu ve Kanıta Dayalı Tedavi Yaklaşımları

“…Fransızcada karaya çıkma ya da gemiden inişte meydana gelen hastalık olarak tanımlanan mal de debarquement sendromu (MdDS), vestibüler sistemi etkileyen sübjektif hareket algısı ile karakterize aşağıyukarı, ileri-geri, sağ-sol yönünde sürekli bir sallantı hissine neden olan ve bir ay veya daha uzun süre devam eden nadir görülen bir nörolojik bozukluktur [1][2][3][4]. İlk kez Irwin ve Darwin tarafından ima edilse de klinik bir sendrom olarak ilk resmi tanımı 1987 yılında Brown ve Baloh tarafından yapılmıştır [5].…”