Mal de Debarquement

Mal de Debarquement

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Mal de Debarquement is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • MdDS

Disorder Subdivisions

  • None

General Discussion

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, with two days being the upper limit of normal. But for persons with MdDS, these sensations may last for 1 month 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, middle aged women are overwhelmingly more likely to come down with MdDS than are men. However, most studies so far have disavowed hormones as a cause.

Symptoms

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. 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, but most typical cases are triggered by boat trips lasting several days.

Causes

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.

Affected Populations

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

Standard Therapies

Diagnosis

The diagnosis of MDDs 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 Dilantin do not appear to work, either. Those medications most frequently prescribed fall into the vestibular suppressants category, including antidepressants or anti-seizure medications. Customized vestibular therapy or various exercise routines are effective in some cases, but no controlled study has been performed that proves that they work.

Investigational Therapies

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:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com



Contact for additional information about mal de debarquement syndrome:



Timothy C. Hain, MD

Professor of Neurology, Orolaryngology, and

Physical Therapy/Human Movement Science

Northwestern University

Chicago, IL 60611

312-274-0197

References

JOURNAL ARTICLES

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.



INTERNET

Mal de debarquement. http://vestibular.org/mal-de-d%C3%A9barquement. Accessed June 1, 2012.

Resources

Vestibular Disorders Association

PO Box 13305

Portland, OR 97208-4467

USA

Tel: (503)229-7705

Fax: (503)229-8064

Tel: (800)837-8428

Email: veda@vestibular.org

Internet: http://www.vestibular.org



NIH/National Institute of Neurological Disorders and Stroke

P.O. Box 5801

Bethesda, MD 20824

Tel: (301)496-5751

Fax: (301)402-2186

Tel: (800)352-9424

TDD: (301)468-5981

Internet: http://www.ninds.nih.gov/



MdDS Balance Disorder Foundation

22406 Shannondell Drive

Audubon, PA 19403

USA

Fax: (210)641-6077

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)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



American Academy of Audiology

11730 Plaza America Drive, Suite 300

Reston, VA 20190

Tel: (703)790-8466

Fax: (703)790-8631

Tel: (800)222-2336

Email: infoaud@audiology.org

Internet: http://www.audiology.org



For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into myCigna.com. For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see http://www.rarediseases.org/search/rdblist.html.

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