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

Abstract

The mal de debarquement syndrome (MdDS) is a movement disorder, occurring predominantly in women, is most often induced by passive transport on water or in the air (classic MdDS), or can occur spontaneously. MdDS likely originates in the vestibular system and is unfamiliar to many physicians. The first successful treatment was devised by Dai et al. (1), and over 330 MdDS patients have now been treated. Here, we report the outcomes of 141 patients (122 females and 19 males) treated 1 year or more ago. We examine the patient’s rocking frequency, body drifting, and nystagmus. The patients are then treated according to these findings for 4–5 days. During treatment, patients’ heads were rolled while watching a rotating full-field visual surround (1). Their symptom severity after the initial treatment and at the follow-up was assessed using a subjective 10-point scale. Objective measures, taken before and at the end of the week of treatment, included static posturography. Significant improvement was a reduction in symptom severity by more than 50%. Objective measures were not possible during the follow-up because of the wide geographic distribution of the patients. The treatment group consisted of 120 classic and 21 spontaneous MdDS patients. The initial rate of significant improvement after a week of treatment was 78% in classic and 48% in spontaneous patients. One year later, significant improvement was maintained in 52% of classic and 48% of spontaneous subjects. There was complete remission of symptoms in 27% (32) of classic and 19% (4) of spontaneous patients. Although about half of them did not achieve a 50% improvement, most reported fewer and milder symptoms than before. The success of the treatment was generally inversely correlated with the duration of the MdDS symptoms and with the patients’ ages. Prolonged travel by air or car on the way home most likely contributed to the symptomatic reversion from the initial successful treatment. Our results indicate that early diagnosis and treatment can significantly improve results, and the prevention of symptomatic reversion will increase the long-term benefit in this disabling disorder.

Coding of Velocity Storage in the Vestibular Nuclei

“…This shows that velocity storage is not only critical for spatial orientation with regard to gravity, but it also serves as an input to the sympathetic system, and motion sickness susceptibility can be reduced by shortening the VOR (velocity storage) time constant ( 94 ). Studies in monkeys also demonstrate that prolonged oscillation in roll while rotating about a spatial vertical axis induces oscillatory modulations of nystagmus ( 95 ) similar to those in patients with the Mal de Debarquement Syndrome (MdDS) ( 94 , 96 , 97 ). Thus, changes in velocity storage are postulated to be responsible for the postural instability induced by prolong travel on water ( 96 ).…”

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). In about 25 percent of the MdDS patients in the 2017 study, the initial improvement of 75 percent fell back to 50 percent after 1 month, but in that 50 percent the improvement was then maintained for a year or more (18).…”

Mal de Debarquement Syndrome

“…The terminology for the non-MT form has been varied, however, including "spontaneous MdDS," "non-MT MdDS," "mixed-MdDS," and "atypical MdDS." 11,17,18 This syndrome has some similarities to persistent perceptual postural dizziness (PPPD), which is a chronic disorder of unsteadiness that can sometimes include a sense of rocking. 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.…”

“…29 conditioning of roll-related neurons in the cerebellar nodulus. 17 Signals from the nodulus drive vestibular-only neurons oscillating at 0.2 to 0.3 Hz in the brainstem. Vestibular signals during the motion trigger are hypothesized to activate the nodulus to produce MdDS.…”

“…A treatment based on this theory to correct for the abnormal VOR cross-coupling has been reported to show high success rates. 17 Using patients with MdDS and a Nintendo Wii board, investigators determined that most patients swayed close to 0.2 Hz. The patients were then exposed to full-field OKN stimulation rotating around the vertical axis away from the side of their vestibular imbalance (the side to which they stepped on the Fukuda test) while their heads were rolled at the frequency they felt (usually close to 0.2 Hz).…”