Mal de debarquement syndrome

Other Names: MdDS; Mal de debarquement; Sickness of disembarkment; Disembarkment syndrome

Mal de debarquement syndrome is a neurological disorder that most commonly develops following an ocean cruise or other type of water travel and less commonly following air travel, train travel, or other motion experiences.

History

MdDS has become increasingly recognized following Brown and Baloh's 1987 case series publication of 6 patients with a persistent motion-induced subjective balance disorder. However, the condition was first described long before then. It was perhaps initially recognized by Hippocrates, who first described nausea, taken from the root word “naus” or “ship” in the Greek language. In his chapter on aphorisms, Hippocrates described his observation that “sailing on the sea shows that motion disorders the body.”2 A more detailed description was provided in 1881 by J.A. Irwin, who remarked on “the unsteady gait sometimes observable in a non-drunken sailor during his first few hours on shore after a long and stormy voyage.”3 Thus, throughout history, MdDS has been recognized time and again as a distinct cause of imbalance. The name of this syndrome, mal de débarquement, originates from a French term dating back to 1575 that translates to “sickness of disembarkment.” Disembarking refers to leaving an aircraft or going ashore after being on a ship. The word “mal” is Latin for “malam,” which translates to “evil.” And for those who have this syndrome, it can certainly seem like they are experiencing something evil!

Signs and symptoms

The symptoms typically reported include: persistent sensation of motion such as rocking, swaying, and/or bobbing, difficulty maintaining balance, anxiety, fatigue, unsteadiness, and difficulty concentrating. The symptoms may be last anywhere from a month to years. Symptoms may or may not go away with time; however, they may reoccur following another motion experience or during periods of stress or illness.

MdDs is associated with a number of other problems, such as insomnia, headache, confusion, blurred vision, disorientation, and in some cases, anxiety and depression. The condition can be debilitating. People with the syndrome feel like they are still on the ship after disembarking, with the ground moving beneath their feet and their head rocking. Paradoxically, the only respite comes from riding in a vehicle such as a train or a car, but the relief is temporary, and symptoms return after the ride.

The new, preliminary findings are based on decades-old experiments by space flight scientists. In a study published in 1962, researchers placed volunteers in a room that rotated slowly, then asked them to move their heads from side to side. The study volunteers developed unusual patterns of eye movements. The results struck Dr. Dai and his colleagues because these types of eye movements are a hallmark of MdDS.

Diagnosis

Simply put, MdDS remains a clinical diagnosis. The features detailed in the clinical history are what support the diagnosis of MdDS in a patient. Of these, the most important are a history of rocking illusory motion following a boat or airplane trip, a relative lack of nausea, and reduction of symptoms with re-exposure to motion (such as when driving or boating). However, the workup in a patient complaining of dizziness could potentially include testing such as VNG, MRI brain, CT temporal bone, audiogram, laboratory studies, or cardiologic evaluation. The tests vary depending on the clinical presentation of the patient. Testing is useful only in helping to exclude other disorders that might present with features similar to MdDS. However, in most classic cases of MdDS, no specific testing is necessary to make the diagnosis. The neurologic examination of a patient with MdDS is notably benign, although patients will convey that they feel constantly disabled by their symptoms or they might appear hesitant on balance tests. Tests include hearing and balance, and MdDS is generally diagnosed by either a neurologist or an ear, nose, and throat specialist.

Treatment

Treatment options for mal de debarquement syndrome (MdDS) are limited. Most drugs that work for other forms of dizziness do not work for MdDS. On some cases, medications classified as vestibular suppressants, such as anti-depressants and anti-seizure medications, may be used. Customized vestibular therapy like optokinetic stimulation has been effective in some cases. In recent years, a renewed interest in understanding the underlying cause of MdDS has led to new treatment options, including repetitive transcranial magnetic stimulation. More studies into these treatment options are needed.

NIH genetic and rare disease info

• NIH info on Mal de debarquement syndrome

Mal de debarquement syndrome is a rare disease.

Mal de debarquement syndrome Resources
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