Mal de debarquement syndrome (MdDS) is a rare and little understood disorder of the body's balance system (vestibular system) and refers to the rocking sensation and/or sense of imbalance that persists for an excessive length of time after an ocean cruise, plane flight or other motion experience. Most people after exposure to an ocean trip or long airplane ride will experience "motion" after the event is over and for a short period of time. But for persons with MdDS, these sensations may last for six months or a year or even many years. Symptoms may diminish in time or periodically disappear and reappear after days, months, or years, sometimes after another motion experience or sometimes spontaneously. This syndrome is probably more common than the literature might lead us to believe, as the level of awareness in the general population as well as among health personnel is very low.
The disproportionate length of time over which the discomfort persists is normally unaccompanied by nausea, nor is it responsive to motion-sickness drugs.
For reasons that are not understood, women are overwhelmingly more likely to come down with MdDS than are men. However, most studies so far have disavowed hormones as a cause.
The primary symptom is the persistence of the sense of motion and rocking for an inordinate length of time after the trip is over. In addition to the persistence of rocking, patients may experience fatigue, confusion, or a feeling of heaviness. Symptoms often increase while the individual is maneuvering in narrow aisles or observing fast movements or flickering lights, or experiencing loud sounds. Patients usually report that the symptoms are most bearable while driving or riding in an auto, but symptoms reoccur soon after completing the trip. Other reported symptoms include migraine headaches, ringing in the ears (tinnitus), ear fullness, ataxia and depression following stress.
Studies have shown that the length of time one is exposed to a motion experience does not determine the severity or duration of the syndrome.
It is likely that MdDS is the result of a failure of the body's balance system to readapt to the environment even after the stimulus is ended. It is much more difficult to understand the cause of the balancing system's failure to readapt. Neurological tests of patients with MdDS fail to detect any distinction between them and control subjects. That is, MdDS patients test normal.
Prevailing opinions concerning the cause of MdDS include the following: a failure of the brain to readapt to solid ground after a motion experience, migraine headaches linked via an unknown mediator or unknown factors within the vestibular system.
Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness, especially among the elderly. It comes about as a result of a movement of the head. Under normal conditions, calcium particles are attached to a specific location within the ear's semicircular canals. As a result of injury, degeneration, or arterial blockage in the ear, these calcium particles clump together causing a sudden and brief episode of dizziness.
Meniere's disease is a disorder characterized by periodic episodes of rotatory vertigo or dizziness; fluctuating, progressive, low-frequency hearing loss; tinnitus; and a sensation of fullness or pressure in the ear.
Diagnosis The diagnosis is based principally upon the exclusion of reasonable alternatives such as those described above. A persistent dizziness after a sea voyage, a sailing trip, a long airplane flight or even a road trip is enough to merit the suspicion of mal de debarquement. A patient's feelings of relief while driving or riding in an auto are other clues. In order to exclude other causes of dizziness, other test may be performed. Such tests will probably include, but may not be limited to, evaluation of hearing, rotary chair testing to evaluate the vestibular ocular reflex, electronystagmography to assess the system of semicircular canals in the ear, assessment of vestibular function to check the capacity to maintain balance.
Treatment Most drugs that work for other forms of dizziness do not work on MdDS. Medications that reduce nerve irritability such as Neurontin and Dilantin do not appear to work, either. Those medications most frequently prescribed fall into the vestibular depressants category, including antidepressants or antiseizure medications. Customized vestibular therapy or various exercize routines are effective in some cases.
Vestibular therapy consists of a group of exercises designed to improve various balance strategies by reducing the dependence on visual cues in the early stages of treatment. Patients typically experience a sense of worsening, prior to eventual improvement. This is because, prior to treatment, patients have found a "groove" that works reasonably well over a limited range of activity. Therapy "teases" the brain away from its previous habits, toward a better groove that works over a much broader range of activity. Patients may become quite uncomfortable during the initial transition. A typical treatment program may involve a few to several formal sessions followed by one or more follow-up sessions on an as-needed basis. Most of the actual therapy is done by the patient at home, frequently with the assistance of other family members.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Teitelbaum P. Mal de debarquement syndrome: a case report. J Travel Med. 2002;9:51-52.
Gordon CR, Shupak A, Nachum Z. Mal de debarquement. Arch Otolaryngol Head Neck Surg. 2000;126:805-06.
Hain TC, Hanna PA, Rheinberger MA. Mal de debarquement. Arch Otolaryngol Head Neck Surg. 1999;125:615-20.
Cohen H. Mild mal de debarquement after sailing. Ann NY Acad Sci. 1996;19:781;598-60.
Gordon CR, Spitzer O, Doweck I, et al. Clinical features of mal de debarquement: adaptation and habituation to sea conditions. J Vestib Res. 1995;5:363-69.
Murphy TP. Mal de debarquement syndrome: a forgotten entity: Otolaryngol Head Neck Surg. 1993;109:10-13.
Gordon CR, Spitzer, Shupak A, et al. Survey of mal de debarquement. BMJ 1992;304:544.
FROM THE INTERNET http://www.groups.yahoo.com/group/mdds_support A support page for people with MdDS
http://www.nhffoundations.net/mdds Public site by the nonprofit MDDS Balance Disorder Foundation, a National Heritage Foundation
http://www.vestibular.org/mdd.html Vestibular Disorders Association. Mal de debarquement. Last updated November 3, 2003. 2pp.
National Institute of Neurological Disorders and Stroke (NINDS) 31 Center Drive 8A07 Bethesda, MD 20892-2540 Tel: (301)496-5751 Fax: (301)402-2186 Tel: (800)352-9424 Email: braininfo@ninds.nih.gov Internet: http://www.ninds.nih.gov/
MdDS Balance Disorder Foundation 22406 Shannondell Drive Audubon, PA 19403 USA Tel: (215)542-9167 Email: mddsfoundation@yahoo.com Internet: http://www.mddsfoundation.org
Genetic and Rare Diseases (GARD) Information Center PO Box 8126 Gaithersburg, MD 20898-8126 Tel: (301)519-3194 Fax: (240)632-9164 Tel: (888)205-2311 TDD: (888)205-3223 Email: gardinfo@nih.gov Internet: http://www.genome.gov/10000409
American Academy of Audiology 11730 Plaza America #300 Reston, VA 20190 Tel: (703)790-8466 Fax: (703)790-8631 Tel: (800)222-2336 Email: info@audiology.org Internet: http://www.audiology.org
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