What is Mal de Débarquement Syndrome?

Jul 28

Mal de Débarquement Syndrome (or MdDS) is a disorder of the vestibular system that is characterized by a chronic perception of self-motion, typically described as a feeling of rocking or swaying. Most MdDS sufferers also describe a feeling of being unstable when they stand or walk.

MdDS can be a remarkably challenging and frustrating condition to live with. The sensation of being constantly in motion can be entirely crazy-making.

How Common is Mal de Débarquement Syndrome?

MdDS is considered to be a rare condition, however it is far from rare in our practice. We see people living with MdDS on a regular basis. It has been suggested that only 1 out of every 100 dizzy patients are suffering from MdDS (1).

MdDS occurs in both women and men, and can be found within all age groups. It appears to be most common in females between the ages of 30–60 (2).

What are the Symptoms of Mal de Débarquement Syndrome?

People living with MdDS report a perceived movement manifesting as a constant feeling of rocking, bobbing, or swaying which seems to be alleviated in passive motion such as riding in a car.

MdDS is usually triggered by motion, however it can flare up spontaneously as well. People who struggle with MdDS often find it is triggered after getting off a moving vehicle (cruise ship, boat, airplane or car), however this is not necessary for a diagnosis of MdDS. Other commonly associated symptoms include nausea and vomiting, headaches, balance issues, brain fog, cognitive fatigue and mood disorders such as anxiety and depression.

MdDS is a challenging disorder and can have a remarkable impact on a person’s quality of life. Symptoms can persist from days to years, and in many cases the condition can be permanent. MdDS is frequently misdiagnosed and generally not well treated with conventional forms of therapy (8).

What Causes Mal de Débarquement Syndrome?

The cause of MdDS is not well-understood. A number of theories have been suggested, including the possibility that MdDS is a disorder of neuroplasticity, and more specifically a disorder of vestibular adaptation (3).

MdDS typically presents after spending time on a boat. The symptoms are first felt when returning to dry land, during which people experience sensations of movement described as having “sea legs.”

When on a boat, people are exposed to continuous movement from the waves. These are in multiple planes, with shifting combinations of roll, pitch and yaw plane movements.

The brain learns to naturally compensate for this movement, such that walking on the moving surface of the boat does not make us unsteady. This compensation is mediated by the vestibulo-ocular reflex (VOR) adaptation processes, possibly including velocity storage mechanisms. VORs are reflexes that allow us to keep our eyes fixed on targets when our head moves, and are critical in the understanding of where our heads are in relation to gravity and the environment. When VOR adaptation takes place, upon returning to land, “sea legs” will remain present until the VOR adaptation is returned to normal. In MdDs, a small number of susceptible individuals may not be able to “turn off” or revert to the prior state of vestibular adaptation. This leaves them with the persistent sensation of rocking that is the hallmark of MdDS.

How is Mal de Débarquement Syndrome Usually Treated?

In a word, poorly. Unfortunately, most conventional forms of therapy are of limited benefit. Traditional vestibular therapy does not appear to be effective for MdDS. Medications are often employed, such as benzodiazepines to help manage anxiety. These do little for the sensation of motion and over time create more problems than they solve (9).

Some researchers see a connection between MdDS and vestibular migraine, and occasionally migraine medications can be partially helpful. Others believe that hormones may play a role, and attempt to address MdDS with hormone replacement therapy. All of these approaches only hope to limit the symptoms and do not address the root cause of the disorder (10).

How is the NeuroRescue Program Different?

MdDS is a result of a mismatch between the two types of vestibular receptors, the otoliths and the semicircular canals, along with dysfunction in the underlying system that allow these to adapt their respective vestibulo-ocular reflexes. These receptors inform the brain about the head’s location in space and in relation to gravity.

MdDS arises from poor integration of these receptors in the vestibular system, as well as with the aspects of the cerebellum that would normally modulate the adaptation of these reflexes (11). In order for our eyes to focus on our environment while we move our head, the vestibular and visual systems precisely coordinate. The poor adaptation of the VOR seen in MdDS provokes the sensations of movement; restoring proper adaptation of the VOR is the key to successful resolution of this condition.

Current research demonstrates that readaptation of the VOR is indeed possible, and can resolve the symptoms of MdDS. In the 2014 study “Readaptation of the vestibulo-ocular reflex relieves the Mal de Debarquement syndrome,” a therapy protocol based on the concept of a maladaptation of the VOR being central to MdDS was advanced. The protocol utilized a specific visual stimulus called optokinetic stimulus (OKN) coupled with simultaneous head movement in the specific direction the patient perceived they were moving. This functioned to help readapt the patient’s VOR and diminish the perception of self-motion. Seventeen of the 24 subjects (70%) became asymptomatic following treatment, and remained so at a 4 months follow-up (4).

Another study from 2017 titled “Sham-Controlled Study of Optokinetic Stimuli as Treatment for Mal de Debarquement Syndrome” successfully reproduced the previous paper’s results in almost half of their patients (5).

We apply these therapy modalities in the NeuroRescue program for all of our MdDS patients. We typically see great success when coupling this treatment with our other rehabilitation modalities.

Other modalities that have proven to be very beneficial for MdDS patients include repetitive Transcranial Magnetic Stimulation (rTMS). This therapy involves an MRI-strength magnetic coil that is used to stimulate areas of the brain directly through the skull. This is a safe, comfortable, and frequently very effective therapy for helping reduce the symptoms of MdDS (6).

Therapies involving Virtual Reality environments have also been shown to be helpful for MdDS (7). We use the Virtualis VR system, which incorporates some of the most advanced technology and applications available in outpatient healthcare. It has been extremely helpful in resolving the sensations of movement and readapting the underlying dysfunction in our MdDS patients.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that are involved in your MdDS. We do this by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your nervous system are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the involved neurons and pathways in your central and peripheral nervous systems. It works to improve energy, endurance, and functional capacity within your involved fragile systems.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to return you to living a healthy, vibrant, and fulfilling life.