Information on the following diseases can be found in the Related Disorders section of this report:

• Benign paroxysmal positional vertigo
• Meniere’s disease

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.

People who come down with MdDS are overwhelmingly female adults although males have also been diagnosed.

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.

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.