Mal De Debarquement Research Articles

Guideline for standardized approach in the treatment of the Mal de Debarquement syndrome.

Mal de Debarquement Syndrome (MdDS) is a debilitating neuro-otological disorder. Patients experience almost continuously a perception of self-motion. This syndrome can be motion-triggered (MT-MdDS), such as on a boat, or occur spontaneously or have other triggers (SO-MdDS) in the absence of such motion. Because the pathophysiological mechanism is unknown, treatment options and symptom management strategies are limited. One available treatment protocol involves a readaptation of the vestibular ocular reflex (VOR). This study assesses the effectiveness of vestibulo-ocular reflex (VOR) readaptation in 131 consecutive patients with a fixed protocol. We administered 131 treatments involving optokinetic stimulation (OKS) paired with a fixed head roll at 0.167 Hz over two to five consecutive days. Each day, four-minute treatment blocks were scheduled twice in the morning and afternoon. Treatment effectiveness was evaluated through questionnaires and posturography. We observed significant improvements in the visual analog scale (VAS), MdDS symptom questionnaire, and posturography measures from pre- to post-treatment. No significant differences were found in outcome variables between MT- and SO-MdDS onsets. Symptoms improved subjectively and objectively in patients' post-treatment. The overall success rate was 64.1%, with no significant difference between MT (64.2%) and SO (63.3%). This study supports the conclusion that VOR readaptation treatment provides relief for two-thirds of MdDS patients, irrespective of the onset type. Based on consistency in the findings, we propose a standardized method for treatment of MdDS based on the OKS with head roll paradigm.

Symptom reduction in mal de débarquement syndrome with attenuation of the velocity storage contribution in the central vestibular pathways.

The velocity storage mechanism of the central vestibular system is closely associated with the vestibulo-ocular reflex (VOR), but also contributes to the sense of orientation in space and the perception of self-motion. We postulate that mal de débarquement syndrome (MdDS) is a consequence of inappropriate sensory adaptation of velocity storage. The premise that a maladapted velocity storage may be corrected by spatial readaptation of the VOR has recently been translated into the development of the first effective treatment for MdDS. However, this treatment's initial impact may be reversed by subsequent re-triggering events. Presently, we hypothesized that MdDS symptoms could alternatively be reduced by attenuating the velocity storage contribution in the central vestibular pathways. Forty-three patients with MdDS (aged 47 ± 14 yo; 36 women) were randomly assigned to two treatment groups and followed for 6 months. The horizontal VOR was tested with chair rotation during laboratory visits, and the strength of velocity storage was quantified with model-based parameters-the time constant (Tc) and the gain of coupling from the vestibular primary afferent signals (g0). To attenuate velocity storage, Group 1 underwent a progressively intensifying series of low-frequency earth-vertical oscillatory rotation coupled to conflicting visual stimuli. Group 2 underwent an established protocol combining head tilts and visual stimulation, designed to correct maladapted spatial orientation but not change the velocity storage strength. The symptom severity was self-rated on an 11-point scale and reported before and up to 6 months after the treatment. In Group 1, velocity storage was modified through reduction of g0 (p < 0.001) but not Tc. The symptom rating was at least halved initially in 43% of Group 1 (p = 0.04), the majority of whom retained a similar level of improvement during the 6-month follow-up period. In Group 2, no systematic change was induced in the parameters of velocity storage strength, as expected. The symptom rating was at least halved initially in 80% of Group 2 (p < 0.001), but paralleling previous findings, symptoms often returned subsequently. Attenuation of velocity storage shows promise as a lasting remedy for MdDS that can complement the VOR readaptation approach.

Assessing the synergistic effectiveness of intermittent theta burst stimulation and the vestibular ocular reflex rehabilitation protocol in the treatment of Mal de Debarquement Syndrome: a randomised controlled trial

IntroductionMal de Debarquement Syndrome (MdDS) is a rare central vestibular disorder characterised by a constant sensation of motion (rocking, swaying, bobbing), which typically arises after motion experiences (e.g. sea, air, and road travel), though can be triggered by non-motion events. The current standard of care is non-specific medications and interventions that only result in mild-to-moderate improvements. The vestibular ocular reflex (VOR) rehabilitation protocol, a specialised form of rehabilitation, has shown promising results in reducing symptoms amongst people with MdDS. Accumulating evidence suggests that it may be possible to augment the effects of VOR rehabilitation via non-invasive brain stimulation protocols, such as theta burst stimulation (TBS).MethodsThe aim of this randomised controlled trial was to evaluate the effectiveness of intermittent TBS (iTBS) over the dorsolateral prefrontal cortex in enhancing the effectiveness of a subsequently delivered VOR rehabilitation protocol in people with MdDS. Participants were allocated randomly to receive either Sham (n = 10) or Active (n = 10) iTBS, followed by the VOR rehabilitation protocol. Subjective outcome measures (symptom ratings and mental health scores) were collected 1 week pre-treatment and for 16 weeks post-treatment. Posturography (objective outcome) was recorded each day of the treatment week.ResultsSignificant improvements in subjective and objective outcomes were reported across both treatment groups over time, but no between-group differences were observed.DiscussionThese findings support the effectiveness of the VOR rehabilitation protocol in reducing MdDS symptoms. Further research into iTBS is required to elucidate whether the treatment has a role in the management of MdDS. TRN: ACTRN12619001519145 (Date registered: 04 November 2019).

Suspected Mal de Debarquement Syndrome: A Case Report Highlighting the Difficulty in Diagnosis and Management.

MdDS is syndrome of oscillating vertigo following cessation of passive motion. The pathogenesis of this disorder is not well understood, but functional imaging studies suggest cortical connectivity dysfunction in feedback loops of the vestibulo-ocular system and visuo-spatial system. Patients go through multiple appointments and often specialist referrals before being diagnosed. After diagnosis, optimal management is difficult. Several treatment modalities, including medication, vestibular rehabilitation, and neuromodulation, have had variable success in management. We present the case of a young, female active duty Air Force Captain who developed symptoms while deployed. She underwent multiple treatments with variable success. Her clinical course highlights the difficulties for patients and providers posed by suspected MdDS.

Hypothesis of Prevalence of Mal De Debarquement Syndrome (MdDS) in Merchant Marines and Navy Employees

Abstract: Objective: Mal de debarquement which is literally called “sickness of disembarkment”, refers to prolonged and infelicitous sensation of movement after exposure to motion and has gained prominence for its attributes and impact on vestibular system. This study addresses the scarcity of research on MdDS’s prevalence and severity on merchant navy, intending to exude flame on the unique challenges faced by this demographic in India. Method: The study enrolled 30 merchant marines and naval officers, including 25males and 5 females aged 25-60 with no previous history of otological issues. The MdDS assessment questionnaire, consisting of 20 questions with a 4-scale rating response (0,1,2,3), assessed the emotional, psychological and behavioural response to sound. It’s categorized via normal, mild, moderate, severe

Understanding Mal de Debarquement syndrome (MdDS), persistent postural perceptual dizziness (3PD) and somatoform disorders: and the role of vestibular rehabilitation therapy (VRT)

It is well established that complaints of dizziness, vertigo, unsteadiness, and internalized motion are commonly reported by patients to health care providers. It is estimated that dizziness is the 3rd most common complaint heard in physicians’ offices across all age groups, preceded only by headache and lower back pain. It has been observed by clinicians for over 100 years, that there is a sizable segment of this population of patients with or without a precedent vertigo episode who report difficulty coping and ambulating comfortably within a visually dynamic world. The purpose of this article is to provide the reader with an understanding of these conditions. This will include definitions of the conditions and a review of their symptoms and management options. The authors will provide a case study to highlight the complex nature of these conditions and successful management approach utilizing Vestibular Rehabilitation Therapy.

The Hidden Enemy: Mal de Débarquement Syndrome andIts Impact onMilitary Operations.

Mal de Débarquement Syndrome (MdDS) is a poorly understood vestibular disorder that frequently affects military personnel exposed to motion during transportation and deployment. It is characterized by a persistent sensation of motion often experienced after disembarking from a ship or other mode of transportation. It can significantly affect a service member's balance, coordination, attention, and focus, which can then substantially impact their quality of life, ability to perform their military duties, and overall mission readiness. Despite its potential impact, comprehensive studies on MdDS are scarce, especially within the military. The unique conditions of military service, including frequent travel, long flights, maritime deployments, and high-stress environments, make the military well suited to study MdDS. Increased awareness and understanding of MdDS is crucial for everyone in the military-from medical personnel responsible for the diagnosis and treatment of MdDS to commanders who must consider the operational impact of impaired personnel.

Questioning the Impact of Vestibular Rehabilitation in Mal de Debarquement Syndrome

Introduction: Mal de debarquement syndrome (MdDS) is a rare and poorly understood clinical entity defined as a persistent sensation of rocking and swaying that can severely affect the quality of life. To date, the treatment options are very limited. Even though vestibular rehabilitation (VR) efficacy following peripheral vestibular lesion is well-documented, little is known about its influence on MdDS. The objective of the study was to explore the influence of traditional VR program on postural control in a patient diagnosed with MdDS. Methods: We assessed 3 different participants: 1 healthy control; 1 participant with identified peripheral vestibular impairment (VI); 1 participant diagnosed with MdDS. Postural control was assessed using a force plate (AMTI, Accusway). Participants were assessed following the modified Clinical Test Sensory Integration Balance protocol (mCTSIB, eyes open on firm surface/eyes closed on firm surface/eyes open on foam/eyes closed on foam). The raw data were exported and analyzed in a custom-made Matlab script (Matlab R2020a). We retrieved the center of pressure velocity in both anterior-posterior and mediolateral directions and performed an analysis of the frequency content using Daubechies wavelet of order 4 with 6 levels of decomposition. Protocol VI and MdDS patients performed a 4-week VR program. Postural control, using a force plate, and Dizziness Handicap Inventory (DHI) were assessed before and after the VR program. Healthy control was assessed twice separated by 1 week without any specific intervention. Results: VI participant showed clear improvement on DHI and sway velocity on condition eyes closed with foam. Accordingly, a reduction of energy content within frequency bands (0.39–0.78 Hz and 0.78–1.56 Hz) was observed post-rehabilitation for VI participant in both conditions with foam. Interestingly, MdDS participant demonstrated a reduction in sway velocity in most of the conditions but the frequency content was not modified by VR and was comparable to healthy control. Accordingly, the DHI of the MdDS participant failed to demonstrate any difference following VR. Conclusion: The results of the present study question the use of VR as an efficient treatment option for MdDS. Future studies must recruit a larger sample size and focus on the relationship between illusion of movement and postural characteristics such as sway velocity.

Management of Migraine-Associated Vestibulocochlear Disorders.

Migraine is a chronic neurological disorder that frequently coexists with different vestibular and cochlear symptoms (sudden hearing loss, tinnitus, otalgia, aural fullness, hyperacusis, dizziness, imbalance, and vertigo) and disorders (recurrent benign positional vertigo, persistent postural perceptual dizziness, mal de debarquement, and Menière's disease). Despite evidence of an epidemiological association and similar pathophysiology between migraine and these vestibulocochlear disorders, patients suffering from migraine-related symptoms are usually underdiagnosed and undertreated. Current migraine treatment options have shown success in treating vestibulocochlear symptoms. Lifestyle and dietary modifications (reducing stress, restful sleep, avoiding migraine dietary triggers, and avoiding starvation and dehydration) and supplements (vitamin B2 and magnesium) offer effective first-line treatments. Treatment with migraine prophylactic medications such as tricyclic antidepressants (e.g., nortriptyline), anticonvulsants (e.g., topiramate), and calcium channel blockers (e.g., verapamil) is implemented when lifestyle and dietary modifications are not sufficient in improving a patient's symptoms. We have included an algorithm that outlines a suggested approach for addressing these symptoms, taking into account our clinical observations. Greater recognition and understanding of migraine and its related vestibular and cochlear symptoms are needed to ensure the appropriate diagnosis and treatment of affected patients.

Mal de Débarquement Syndrome in Children: A Case Series

Currently, mal de débarquement syndrome (MdDS) has been reported only among adults. This case series describes three pediatric MdDS patients. MdDS presentation in children is similar to that of adults, although frequency of comorbid conditions is greater. Diagnostic delays are common and likely due to under recognition of MdDS among children.

Mal de Debarquement Syndrome Complicated by Psychiatric Comorbidities

Mal de Debarquement Syndrome Complicated by Psychiatric Comorbidities

Mal de Debarquement Syndrome explained by a vestibulo-cerebellar oscillator.

Mal de Debarquement Syndrome (MdDS) is a puzzling central vestibular disorder characterized by a long-lasting perception of oscillatory postural instability that may occur after sea travels or flights. We have postulated that MdDS originates from the post-disembarking persistence of an adaptive internal oscillator consisting of a loop system, involving the right and left vestibular nuclei, and the Purkinje cells of the right and left flocculonodular cerebellar cortex, connected by GABAergic and glutamatergic fibers. We have formulated here a mathematical model of the vestibulo-cerebellar loop system and carried out a computational analysis based on a set of differential equations describing the interactions among the loop elements and containing Hill functions that model input-output firing rates relationships among neurons. The analysis indicates that the system acquires a spontaneous and permanent oscillatory behavior for a decrease of threshold and an increase of sensitivity in neuronal input-output responses. These results suggest a role for synaptic plasticity in MdDS pathophysiology, thus reinforcing our previous hypothesis that MdDS may be the result of excessive synaptic plasticity acting on the vestibulo-cerebellar network during its entraining to an oscillatory environment. Hence, our study points to neuroendocrine pathways that lead to increased synaptic response as possible new therapeutic targets for the clinical treatment of the disorder.

Visual Disorders and Mal De Debarquement Syndrome: a Potential Comorbidity questionnaire-based Study

Aim:Mal de debarquement syndrome (MdDS) is a neurological condition characterized by a constant sensation of self-motion; onset may be motion-triggered (MT) or non-motion-triggered/spontaneous (NMT/SO). People with MdDS experience similar symptoms to those with vertical heterophoria, a subset of binocular visual dysfunction. Hence, we aimed to explore potential visual symptom overlaps.Methods:MdDS patients (n = 196) and controls (n = 197) completed a visual health questionnaire.Results:Compared with controls, the MdDS group demonstrated higher visual disorder scores and visual complaints. NMT/SO participants reported unique visual symptoms and a higher prevalence of mild traumatic brain injury.Conclusion:Our findings suggest visual disorders may coexist with MdDS, particularly the NMT/SO subtype. The difference in visual dysfunction frequency and medical histories between subtypes, warrants further investigation into differing pathophysiological mechanisms.

Treatment of Mal de Debarquement Syndrome in an Audiology-Vestibular Clinic.

Mal de Debarquement Syndrome (MdDS) has a stereotypical presentation of symptoms including continuous rocking/swaying sensations described as feeling like one is "still on the boat," following travel, especially on water vessels. MdDS is even more notorious for the duration of symptoms that can persist months or years, and historically this condition has escaped effective treatments. This case study presents a case of classic MdDS that was effectively treated in an Audiology-Vestibular clinic. Treatment consisted of three, relatively short-lived vestibular rehabilitation sessions using the "Roll Readaptation" technique that has previously been reported in Neurology journals. The study sample includes a 48-year-old female with a history of MdDS following two separate ocean cruises. She underwent vestibular evaluation and was treated with a treatment paradigm aimed to readapt the central vestibular system and vestibular-ocular reflex. This report focuses on a brief review of current symptomology and diagnostic criteria of MdDS, underlying pathophysiology and application of a relatively new treatment technique in an audiology clinic. This patient was shown full-field, omni-directional optokinetic (OPK) stimulus while rolling her head rhythmically for up to 4 minutes at a time. After three treatment sessions, the patient had a significant reduction in subjective symptoms and returned to full-time work. She had previously been off work for nearly 3 months. Individuals with MdDS suffer large daily and work life disruptions due to the persistent nature of symptoms, and their physical manifestations. In addition, they have historically had minimal treatment options. This case demonstrates that audiologists with proper equipment may have the potential to readily offer treatment for a previously "untreatable" condition.

Vestibular rehabilitation for individuals with mal de debarquement syndrome: a systematic review

Background Mal de debarquement syndrome (MdDS) is a pathological condition characterized by rocking, swaying, and/or a sense of imbalance. The two types of MdDS are known as motion triggered MdDS and spontaneous or other onset MdDS. Objectives The purpose of this systematic review was to evaluate the effectiveness of vestibular rehabilitation on individuals experiencing the symptoms of MdDS using valid and reliable outcome measures. Methods MEDLINE, ProQuest Medical Database, and Web of Science were the databases utilized in the search process. The search terms included ‘mal de debarquement’ AND ‘intervention’ OR ‘management’ OR ‘rehabilitation’ OR ‘therapy’ OR ‘treatment’. The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence was utilized in evaluating the evidence level for all of the included articles, and a 10-item tool created by Medlicott and Harris was utilized in evaluating the methodological rigor for all of the included articles. Results Seven articles met the eligibility requirements based upon the inclusion and exclusion criteria, and these articles were qualitatively analyzed. The intervention focused on traditional vestibular rehabilitation in two of the studies and on optokinetic stimulation in the other five studies. Optokinetic stimulation is designed to induce re-adaptation of the vestibulo-ocular reflex. This systematic review found that optokinetic stimulation required a much shorter treatment duration than traditional vestibular rehabilitation to significantly improve the balance and decrease the symptoms of individuals affected with MdDS. Conclusions Clinicians should consider using optokinetic stimulation when treating individuals diagnosed with MdDS, especially those with the motion-triggered subtype.

Приступы головокружения: дифференциальная диагностика и подходы к терапии

The article deals with diseases manifested by episodic vestibular syndrome in the form of dizziness attacks of varying duration. Presented modern clinical criteria for diagnosis and principles of effective therapy of benign paroxysmal positional vertigo, vestibular migraine, Meniere's disease, upper semicircular canal degeneration, vestibular paroxysmia, Mal de Debarquement syndrome, etc.

Sudden Onset of Vestibular Migraine Complicated with BPPV and Mal de Debarquement Syndrome – a Diagnostic Dilemma

Vestibular migraine is combination of migraine and vestibular symptoms. In clinical examination it can be replaced with benign paroxysmal positional vertigo (BPPV) cupulolithiasis, but also BPPV is common comorbidity in migraine patients. There is also high association between vestibular migraine and Mal de Debarquement syndrome. Patient came to hospital with vertigo that was diagnosed as left PC-BPPV canalolithiasis. After first Epley's maneuver symptoms didn't resolved. Week after, at second Epley's maneuver performed patient developed left PC-BPPV cupulolithiasis. Month after, at third Epley's maneuver BPPV resolved but patient developed Mal de Debarquement syndrome. Laboratory testing showed hyperhomocisteinemia and homozygous MTHFR C677T and PAI, with low vitamin D. After reviewing the vestibular symptoms in the first attack which was misdiagnosed as BPPV canalolithiasis, and history of migraine, patient was diagnosed with vestibular migraine. Patient well responded to migraine diet and supplementation with B complex. Vestibular disorders are similar to each other and they can overlap. More attention in taking detailed medical history should be given to patients with vertigo or dizziness.

Remotely Monitored Home-Based Neuromodulation With Transcranial Alternating Current Stimulation (tACS) for Mal de Débarquement Syndrome.

Objective: To determine whether remotely-monitored transcranial alternating current stimulation (tACS) may be a viable and safe treatment option for Mal de Débarquement Syndrome (MdDS).Background: Mal de Débarquement Syndrome is a neurotological disorder characterized by persistent oscillating vertigo that is triggered by entrainment to passive oscillatory motion such as occurs during water-based travel. Treatment options for MdDS are limited, variably effective, and can be undone by further travel.Design and Methods: This was a remotely-monitored open-label optional extension phase of a double-blind randomized onsite study of tACS for medically refractory MdDS. The primary goal was to determine safety, feasibility, and blinded participant feedback. The secondary goal was to determine efficacy. Thirteen participants (all women), aged 22–67 years, experiencing a duration of illness of 11–72 months, were a subset of 24 individuals who participated in an on-site study of tACS. They had either not responded to the on-site protocol or had relapsed after travel home. Treatment accessories and a tablet controlled tACS stimulator (Pulvinar XCSITE-100) were mailed to participants. Three teaching sessions were performed via webcam followed by on-going remote monitoring of treatment logs and participants' reports through a daily on-line diary and weekly questionnaires. Treatment continued until an effective protocol was administered for 4 weeks and then tapered over 4 weeks. Participants completed a blinded feedback survey and a debriefing interview at the completion of the entire study.Results: Treatment duration ranged from 4 to 31 weeks followed by a 4-week taper accounting for 578 verified sessions. Of the 13 total participants, seven agreed or agreed strongly in the blinded survey that tACS treatment was beneficial; 2) Twelve were comfortable utilizing tACS on their own; 3) Eleven preferred stimulation above their individual alpha frequency; 4) Side effects were generally mild and typical of tACS. In the debriefing interview completed 2–9 months after the last stimulation, five participants reported doing “great,” with no to minimal symptoms, four reported doing “good,” with moderate symptoms, and four reported no change compared to pre-study baseline.Conclusion: Remotely-monitored tACS may be a safe treatment option for MdDS with the potential for lasting outcomes, increased accessibility, and reduction in travel-related treatment reversal.

Influence of sex hormones on vestibular disorders.

Vestibular disorders are gender distributed with a higher prevalence in women. Although research has increased in this field, the mechanisms underlying this unbalance is unclear. This review summarises recent advances in this research sphere, and briefly discusses sex hormone effects on various vestibular conditions and highlights some recent theories. Recent work has identified a direct link between aberrant gonadal hormone levels and vestibular dysfunction. Benign paroxysmal positional vertigo research suggests that the disorder may be linked to the rapid decrease in oestrogen, observed in menopausal women, which disrupts otoconial metabolism within the inner ear. A successful hormonal therapeutic intervention study has advanced our knowledge of hormonal influences in the inner ear in Ménière's disease. Also, several studies have focused on potential mechanisms involved in the interaction between Vestibular Migraine, Mal de Debarquement Syndrome, and gonadal hormones. In females, gonadal hormones and sex-specific synaptic plasticity may play a significant role in the underlying pathophysiology of peripheral and central vestibular disorders. Overall, this review concludes that clinical assessment of female vestibular patients requires a multifaceted approach which includes auditory and vestibular medicine physicians, gynaecologists and/or endocrinologists, in conjunction with hormonal profile evaluations.

Brain network effects by continuous theta burst stimulation in mal de débarquement syndrome: simultaneous EEG and fMRI study

Objective. Heterogeneous clinical responses to treatment with non-invasive brain stimulation are commonly observed, making it necessary to determine personally optimized stimulation parameters. We investigated neuroimaging markers of effective brain targets of treatment with continuous theta burst stimulation (cTBS) in mal de débarquement syndrome (MdDS), a balance disorder of persistent oscillating vertigo previously shown to exhibit abnormal intrinsic functional connectivity. Approach. Twenty-four right-handed, cTBS-naive individuals with MdDS received single administrations of cTBS over one of three stimulation targets in randomized order. The optimal target was determined based on the assessment of acute changes after the administration of cTBS over each target. Repetitive cTBS sessions were delivered on three consecutive days with the optimal target chosen by the participant. Electroencephalography (EEG) was recorded at single-administration test sessions of cTBS. Simultaneous EEG and functional MRI data were acquired at baseline and after completion of 10–12 sessions. Network connectivity changes after single and repetitive stimulations of cTBS were analyzed. Main results. Using electrophysiological source imaging and a data-driven method, we identified network-level connectivity changes in EEG that correlated with symptom responses after completion of multiple sessions of cTBS. We further determined that connectivity changes demonstrated by EEG during test sessions of single administrations of cTBS were signatures that could predict optimal targets. Significance. Our findings demonstrate the effect of cTBS on resting state brain networks and suggest an imaging-based, closed-loop stimulation paradigm that can identify optimal targets during short-term test sessions of stimulation. ClinicalTrials.gov Identifier: NCT02470377.