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

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.

[1]  A GRAYBIEL,et al.  Compensatory nystagmus conditioned during adaptation to living in a rotating room. , 1962, Journal of applied physiology.

[2]  A GRAYBIEL,et al.  VESTIBULAR HABITUATION DURING REPETITIVE COMPLEX STIMULATION: A STUDY OF TRANFER EFFECTS. , 1964, Journal of applied physiology.

[3]  A. Graybiel,et al.  Residual effects of storm conditions at sea upon the postural equilibrium functioning of vestibular normal and vestibular defective human subjects.NSAM-935. , 1965, Research report. Naval School of Aviation Medicine.

[4]  B Cohen,et al.  Semicircular canal nerve eye and head movements. The effect of changes in initial eye and head position on the plane of the induced movement. , 1966, Archives of ophthalmology.

[5]  G. Singleton,et al.  Relationships of the cerebellar nodulus to vestibular function: A study of the effects of nodulectomy on habituation , 1967, The Laryngoscope.

[6]  A Graybiel,et al.  Rapid vestibular adaptation in a rotating environment by means of controlled head movements. , 1969, Aerospace medicine.

[7]  F. Guedry,et al.  Coriolis cross-coupling effects: disorienting and nauseogenic or not? , 1978, Aviation, space, and environmental medicine.

[8]  R T Schmitke,et al.  SHIP SWAY, ROLL, AND YAW MOTIONS IN OBLIQUE SEAS , 1978 .

[9]  S. Krafczyk,et al.  POSTURAL IMBALANCE WITH HEAD EXTENSION: IMPROVEMENT BY TRAINING AS A MODEL FOR ATAXIA THERAPY * , 1981, Annals of the New York Academy of Sciences.

[10]  R. Baloh,et al.  Persistent mal de debarquement syndrome: a motion-induced subjective disorder of balance. , 1987, American journal of otolaryngology.

[11]  B. Cohen,et al.  Spatial orientation of the vestibular system: dependence of optokinetic after-nystagmus on gravity. , 1991, Journal of neurophysiology.

[12]  H. Shojaku,et al.  Vestibularly induced slow oscillations in climbing fiber responses of Purkinje cells in the cerebellar nodulus of the rabbit , 1992, Neuroscience.

[13]  D. Robinson,et al.  Context-specific adaptation of the gain of the vestibulo-ocular reflex in humans. , 1992, Journal of vestibular research : equilibrium & orientation.

[14]  D E Angelaki,et al.  The cerebellar nodulus and ventral uvula control the torsional vestibulo-ocular reflex. , 1994, Journal of neurophysiology.

[15]  D E Angelaki,et al.  Lesion of the nodulus and ventral uvula abolish steady-state off-vertical axis otolith response. , 1995, Journal of neurophysiology.

[16]  Y. Melamed,et al.  Clinical features of mal de debarquement: adaptation and habituation to sea conditions. , 1995, Journal of vestibular research : equilibrium & orientation.

[17]  Vertigo after sailing a nineteenth century ship. , 1996, Journal of vestibular research : equilibrium & orientation.

[18]  B Cohen,et al.  Control of the three-dimensional dynamic characteristics of the angular vestibulo-ocular reflex by the nodulus and uvula. , 1997, Progress in brain research.

[19]  B Cohen,et al.  Control of Spatial Orientation of the Angular Vestibulo‐Ocular Reflex by the Nodulus and Uvula of the Vestibulocerebellum , 1999, Annals of the New York Academy of Sciences.

[20]  B. Cohen,et al.  The ultrastructure of GABA-immunoreactive vestibular commissural neurons related to velocity storage in the monkey , 1999, Neuroscience.

[21]  B. Cohen,et al.  Ultrastructure of vestibular commissural neurons related to velocity storage in the monkey , 1999, Neuroscience.

[22]  T C Hain,et al.  Mal de debarquement. , 1999, Archives of otolaryngology--head & neck surgery.

[23]  L R Young,et al.  Artificial gravity: head movements during short-radius centrifugation. , 2001, Acta astronautica.

[24]  S. Eckstein.  Ethical principles for medical research involving human subjects. , 2001, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[25]  Theodore Raphan,et al.  The vestibulo-ocular reflex in three dimensions , 2002, Experimental Brain Research.

[26]  Wolzt,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2003, The Journal of the American College of Dentists.

[27]  B. Cohen,et al.  The relation of motion sickness to the spatial–temporal properties of velocity storage , 2003, Experimental Brain Research.

[28]  B. Cohen,et al.  Adaptive Changes in the Angular VOR: Duration of Gain Changes and Lack of Effect of Nodulo‐Uvulectomy , 2003, Annals of the New York Academy of Sciences.

[29]  Sergei B. Yakushin,et al.  Dependence of adaptation of the human vertical angular vestibulo-ocular reflex on gravity , 2003, Experimental Brain Research.

[30]  B. Cohen,et al.  Effects of midline medullary lesions on velocity storage and the vestibulo-ocular reflex , 2004, Experimental Brain Research.

[31]  H. Reisine,et al.  Neural basis for eye velocity generation in the vestibular nuclei of alert monkeys during off-vertical axis rotation , 2004, Experimental Brain Research.

[32]  Richard F. Lewis.  Frequency-specific mal de debarquement , 2004, Neurology.

[33]  Christiane,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2004, Journal international de bioethique = International journal of bioethics.

[34]  B. Cohen,et al.  Velocity storage in the vestibulo-ocular reflex arc (VOR) , 1979, Experimental Brain Research.

[35]  Theodore Raphan,et al.  Habituation and adaptation of the vestibuloocular reflex: a model of differential control by the vestibulocerebellum , 2004, Experimental Brain Research.

[36]  David Solomon,et al.  Stimulation of the nodulus and uvula discharges velocity storage in the vestibulo-ocular reflex , 2004, Experimental Brain Research.

[37]  B. Cohen,et al.  The Physiology of the Vestibuloocular Reflex (VOR) , 2004 .

[38]  G. Paige,et al.  The squirrel monkey vestibulo-ocular reflex and adaptive plasticity in yaw, pitch, and roll , 2004, Experimental Brain Research.

[39]  Laurence R. Young,et al.  Adaptation to head movements during short radius centrifugation , 2007 .

[40]  R. Clendaniel,et al.  Retention of VOR gain following short-term VOR adaptation , 2008, Experimental Brain Research.

[41]  C. Sabatti,et al.  Clinical features and associated syndromes of mal de debarquement , 2008, Journal of Neurology.

[42]  S. Demura,et al.  Power Spectrum Characteristics of Sway Position and Velocity of the Center of Pressure during Static Upright Posture for Healthy People , 2008, Perceptual and motor skills.

[43]  B. Cohen,et al.  Dependence of the roll angular vestibuloocular reflex (aVOR) on gravity. , 2009, Journal of neurophysiology.

[44]  Theodore Raphan,et al.  Adaptation of the angular vestibulo-ocular reflex to head movements in rotating frames of reference , 2009, Experimental Brain Research.

[45]  D. Angelaki,et al.  The functional significance of velocity storage and its dependence on gravity , 2011, Experimental Brain Research.

[46]  Mingjia Dai,et al.  Prolonged reduction of motion sickness sensitivity by visual-vestibular interaction , 2011, Experimental Brain Research.

[47]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[48]  A M Bronstein,et al.  Prolonged asymmetric vestibular stimulation induces opposite, long‐term effects on self‐motion perception and ocular responses , 2013, Journal of Physiology.

[49]  B. Cohen,et al.  Readaptation of the Vestibulo-Ocular Reflex Relieves the Mal De Debarquement Syndrome , 2014, Front. Neurol..

[50]  A. Van Ombergen,et al.  Mal de debarquement syndrome: a systematic review , 2015, Journal of Neurology.

[51]  B. Cohen,et al.  Mal de débarquement syndrome. , 2015, Neurology. Clinical practice.

[52]  Yoon-Hee Cha,et al.  Double-Blind Sham-Controlled Crossover Trial of Repetitive Transcranial Magnetic Stimulation for Mal de Debarquement Syndrome , 2016, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[53]  B. Yates,et al.  Descending Influences on Vestibulospinal and Vestibulosympathetic Reflexes , 2017, Front. Neurol..