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.
Highlights
The mal de debarquement syndrome (MdDS) is a maladapted vestibular movement disorder characterized by continuous rocking, swaying, or bobbing that can follow a cruise, flight, or ground transport and can occur spontaneously [1,2,3,4,5,6,7]
The medical community is generally unaware that the MdDS is a characteristic set of signs and symptoms, and the patients who came to us most frequently had a full medical workup with many medical tests, costing thousands of dollars by the time that these patients were diagnosed and referred
Despite the setback from the initial effectiveness of the treatment, we are pleased that we still achieved a significant improvement in about 50% of classic and spontaneous MdDS patients after 1 year of observation
Summary
The mal de debarquement syndrome (MdDS) is a maladapted vestibular movement disorder characterized by continuous rocking, swaying, or bobbing that can follow a cruise, flight, or ground transport (the classic MdDS) and can occur spontaneously [1,2,3,4,5,6,7]. Simple head roll along the naso-occipital axis only produces torsional eye movements and/or nystagmus without a component in pitch [11, 12]. Similar results were produced by roll while rotating in cynomolgus monkeys [14] This is an unusual vestibular stimulus that we designate as a cross-axis-coupled stimulus [9] because the third axis of eye movement is produced by a cross-product of the other two axes [15] and has been used in training astronauts for mitigating motion sickness susceptibility [9, 16,17,18]. A cross-axis-coupled stimulus can alter velocity storage of the VOR [19, 20] to produce persistent, abnormal eye movements [1, 14, 21]
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