Abstract
There has been increasing awareness that post-motion triggered rocking self-vertigo can last for months or years, a disorder known as Mal de Debarquement Syndrome (MdDS). A similar feeling of oscillating self-motion can occur without a motion trigger in some individuals, leading to controversy about whether motion triggered (MT) and non-motion triggered (non-MT) symptoms ultimately represent the same disorder. Recognizing the similarities and differences between MT and non-MT MdDS can prevent unnecessary diagnostic testing and lead to earlier and more effective treatments. Standardized questionnaire assessment and follow-up interviews of individuals with persistent MT or non-MT MdDS (>1 month) examined at a University Dizziness Clinic. Questionnaires were available on 80 individuals with persistent MT MdDS and 42 with non-MT MdDS. Sex distribution (81% female) and age of onset (mean 43.4 ± 12.2 years MT; 42.1 ± 15.2 years non-MT) were comparable between MT and non-MT MdDS (p > 0.05). Mean duration of illness was significantly longer in the non-MT group (82.8 ± 64.2 months) than the MT group (35.4 ± 46.4 months) (p < 0.001). There was no correlation between trigger type and age of onset or duration of illness for MT MdDS. Improvement with re-exposure to motion (driving) was typical for both (MT = 89%, non-MT = 64%), but non-MT individuals more frequently had symptoms exacerbated with motion (MT = 0%; non-MT = 10%). Peri-menstrual and menstrual worsening of symptoms was typical in both MT and non-MT MdDS (each 71%). Both MT and non-MT MdDS exhibited a higher population baseline prevalence of migraine (23% and 38%, respectively). Benzodiazepines and SSRI/SNRIs were helpful in both subtypes of MdDS (>50% individuals with a positive response). Physical therapy was modestly helpful in the MT (56%) subtype but not in non-MT (15%). Vestibular therapy made as many individuals worse as better in MT and none improved in the non-MT group. General demographic characteristics and exacerbating factors are similar in MT and non-MT MdDS, but there are differences in the duration of illness, effect of motion on symptoms, and response to therapy. Recognizing clinical features of MdDS subtypes may allow for better tailoring of therapy and potentially serve as classification criteria for new clinical designations.
Highlights
Historical references to the phenomenon of landsickness date back to the seventeenth century, but recognition of a clinical entity characterized by prolonged landsickness, “Mal de Debarquement Syndrome,” (MdDS), has only occurred in the second half of the twentieth century [1,2,3,4,5]
In the case of non-motion triggered (MT) MdDS, symptoms had to start without any significant travel within the month before the onset
If a participant had experienced both MT and non-motion triggered (non-MT) episodes, they were categorized according to their last episode, yielding 80 MT and 42 non-MT designations
Summary
Historical references to the phenomenon of landsickness date back to the seventeenth century, but recognition of a clinical entity characterized by prolonged landsickness, “Mal de Debarquement Syndrome,” (MdDS), has only occurred in the second half of the twentieth century [1,2,3,4,5]. The post-motion triggered feeling of “rocking” as if one was “still on the boat,” that follows sea, air, or land-based motion is a common experience in otherwise healthy individuals, occurring with a prevalence of about 70% [6,7,8,9,10] These short bouts of motion triggered (MT) symptoms last for two or fewer days and are referred to as “landsickness.” In some cases, the symptoms can persist for months or years, putting the syndrome into the category of MdDS [11, 12]. The International Classification of Vestibular Disorders defined vertigo as the “sensation of self-motion when no self-motion is occurring or the sensation of distorted self-motion during an otherwise normal head movement.” In this broad sense, the experience of MdDS is a form of vertigo [13]. Recognizing the similarities and differences between MT and non-MT MdDS can prevent unnecessary diagnostic testing and lead to earlier and more effective treatments
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