Abstract
Mal de Debarquement Syndrome (MdDS) is a condition characterized by a persistent perception of self-motion, in most cases triggered from exposure to passive motion (e.g., boat travel, a car ride, flights). Patients whose onset was triggered in this way are categorized as Motion-Triggered (MT) subtype or onset group. However, the same syndrome can occur spontaneously or after non-motion events, such as childbirth, high stress, surgery, etc. Patients who were triggered in this way are categorized as being of the Spontaneous/Other (SO) subtype or onset group. The underlying pathophysiology of MdDS is unknown and there has been some speculation that the two onset groups are separate entities. However, despite the differences in onset between the subtypes, symptoms are parallel and a significant female predominance has been shown. To date, the role of gonadal hormones in MdDS pathophysiology has not been investigated. This study aimed to evaluate the hormonal profile of MdDS patients, the presence of hormonal conditions, the influence of hormones on symptomatology and to assess possible hormonal differences between onset groups. In addition, the prevalence of migraine and motion sickness and their relation to MdDS were assessed. Retrospective online surveys were performed in 370 MdDS patients from both onset groups. Data were analyzed using Fisher's exact test or Fisher-Freeman-Hanlon exact test. When possible, data were compared with normative statistical data from the wider literature. From the data collected, it was evident that naturally cycling female respondents from the MT group were significantly more likely to report an aggravation of MdDS symptoms during menses and mid-cycle (p < 0.001). A few preliminary differences between the onset groups were highlighted such as in regular menstrual cycling (p = 0.028), reporting menses during onset (p < 0.016), and migraine susceptibility after onset (p = 0.044). These results demonstrate a potential relation between hormone fluctuations and symptom aggravation in the MT group. This study is an important first step to suggest a hormonal involvement in the pathophysiology of MdDS and provides a base for further hormonal investigation. Future prospective studies should expand upon these results and explore the implications for treatment.
Highlights
Mal de Debarquement syndrome (MdDS) has only recently gained greater awareness across the medical and scientific community, though it is still deemed a rare and poorly understood neurological disorder that affects the vestibular system
A clinical assessment of female and male hormonal profiles and underlying hormonal conditions should be performed to elucidate possible mechanisms behind the development of MdDS, and provide direction for potential MdDS hormonal treatment strategies. This was the first global survey, with the highest number of MdDS respondents that attempted to identify a link between MdDS and gonadal hormones
It is evident that hormonal fluctuations are able to influence the symptomology of female MdDS patients, which we hypothesize is due to estrogen withdrawal
Summary
Mal de Debarquement syndrome (MdDS) has only recently gained greater awareness across the medical and scientific community, though it is still deemed a rare and poorly understood neurological disorder that affects the vestibular system. It is characterized by a chronic perception of self-motion, including rocking, swaying and bobbing. MdDS has been described as the result of a maladaptive integration of multiple sensory information sources (6) It has been hypothesized as a maladaptation of the vestibular ocular reflex, resulting in an altered velocity storage mechanism (7). MdDS has been described as a disorder of neuroplasticity (4, 5, 8)
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