Mal De Debarquement Syndrome (MDDS)

  WHAT IS MAL DE DEBARQUEMENT SYNDROME (MDDS)? Mal de debarquement syndrome is a rare and poorly understood neurological disorder of the vestibular system that results in a phantom perception of self-motion typically described as rocking, swaying, or bobbing.  There is no known cure for MDDS. But your doctor can recommend some mal de debarquement syndrome exercises to help keep to stable. MDDS may be attributed to exposure to an unfamiliar movement and then the removal of the movement, like after sea travel. For example, stepping off a boat and feeling like you are still moving.  Mal de debarquement syndrome is commonly developed following motion experiences, such as air travel, sea travel, rail or land travels, and typified by the persistent sensation of motion, difficulty in maintaining balance, fatigue, unsteadiness, anxiety, and lack of concentration.  MDDS is more common in women within the age group of 30─60 years. RISKS OF MDDS Mal de debarquement is a balance disorder that carries significant risks of adverse effects (morbidity), due to direct effects of the balance impairment and other associated symptoms.  The adverse effects of MDDS may include:

• Balance impairment (rocking, swaying, and bobbing).
• Persistent vertigo, due to height.
• Visual motion intolerance.
• Fatigue.
• Cognitive slowing.
• Confusion.
• Anxiety.
• Depression.
• Feeling of tiredness.
• Focus inabilities.

RISK FACTORS OF MDDS

• Gender.

The majority of people affected by MDDS are adult females, although males have been diagnosed.

• Age.

The commonly affected people are in their middle age. Women of age 30─60 years are mostly affected.

• Migraine.

Patients with migraines may have an increased susceptibility through unknown mechanisms. OTHER RELATED DISORDERS

• Benign Paroxysmal Positional Vertigo (BPPV).

This commonly causes dizziness, especially among the elderly. It occurs as a result of a movement of the head. It is a rare disease caused by calcium particles in the inner ear.

• Meniere’s Disease.

This is a disorder characterized by periodic episodes of vertigo or dizziness, fluctuating progressive hearing loss, tinnitus, and a sensation of fullness or pressure in the ear. DIAGNOSIS OF MDDS Your doctor may want to know about our medical history and give a special focus on your MDDS symptoms and travel experiences (via air, land, rail, sea, etc).

• Blood tests.
• Vestibular function test to check your balance. This test is important in excluding other etiologies for your symptoms.
• Vision tests.
• Hearing exam.
• Imaging scan of our brain.
• MRI scan to ensure your nervous system is okay.

TREATMENTS FOR MDDS Mal de debarquement syndrome is very difficult to treat, with few effective responses from most treatments.

• Medications.
• Clonazepam.

At low doses, once or twice daily, this medicine has shown improvement in patients. Higher doses have not proven to be effective.

• Diazepam (Valium).
• Histamine blockers or antihistamines (Benadryl).

Take one gel tablet at the beginning of the air flight, then at every 4 hours interval for longer flights. Medications for treating depression, anxiety, and insomnia may be useful for MDDS. Motion medications are not effective and should not be used.

• Brain Stimulation Therapy. 

Repetitive transcranial magnetic stimulation (rTMS) has proven effective for ‘mal de debarquement’.

• Vestibular Rehabilitation Therapy.
• Lifestyle Self Care.

For mal de debarquement treatment, exercises are necessary. It is advisable to take care of yourself by routine exercises, managing stress, and getting adequate rest. It is also necessary to take healthy diets. CONCLUSION Studies have shown that a short period of MDDS symptoms is common in healthy persons, after prolonged episodes of inactive motions, normally lasting seconds to three days.  Nevertheless, in MDDS, notable balance impairment can persist for months and even up to years. The disorder has no known cure yet. However, treating the underlying causes with the help of a combination of medications has yielded great results and led to a better quality of life.

Symptoms

MDDS SYMPTOMS

The symptoms of mal de debarquement may last anywhere from a month to years. The symptoms may or may not go away with time. However, recurrence of symptoms following another motion experience is typical of MDDS. 

The signs may tend to worsen when a patient is in an enclosed place or is attempting to be motionless, such as lying down in bed. The common symptoms include:

• Feeling of rocking, swaying, or bobbing (unsteady staggering episodes.
• Anxiety.
• Depression.
• Feeling of tiredness.
• Persistent vertigo.
• Confusion.
• Difficulty in focusing.

Your symptoms may get worse when you are:

• Tired.
• Stressed.
• On fast movement.
• In an enclosed space.
• Observe flickering lights.
• Trying to be still, like when going to sleep.
• On intense visual activity, like playing video games.

Causes

CAUSES OF MDDS

The real cause of mal de debarquement syndrome is yet unknown. Some researches made believe that the problem is not in the inner but rather in the brain. 

According to them, their explanation is based upon studies that have demonstrated changes in the brain metabolism and functional brain connections of those who have the disorder. 

They resolved that because of these changes, the brain can adapt to an unfamiliar movement but is unable to readapt once the movement has stopped.

The following are some conditions that trigger or lead to MDDS:

• Elevators.
• Water beds.
• Walking on docks.
• Using virtual reality.
• When you have been out on the sea or riding in planes, trains, and cars (motion experiences).

FAQ

How long does mal de debarquement last?

Studies have shown that a short period of MDDS symptoms is common in healthy persons, after prolonged episodes of inactive motions, normally lasting seconds to three days. 

What helps with MDDS?

Low doses of clonazepam, a benzodiazepine medication related to Valium (diazepam), are helpful in most persons with mal de debarquement. There is some worry that these medications may prolong the duration of symptoms (although worry has not been tested by research study).

Can swimming cause MDDS?

Mal de debarquement syndrome is typically by passive motion, cars, trains, airplanes, ships, boats, and fast elevators. Virtual reality, water beds, and even swimming can all cause the disorder.

How do I get rid of MDDS?

Currently, there is no single highly successful treatment approach for ‘mal de debarquement’. Standard drugs prescribed for motion sickness (including meclizine and scopolamine patches) are usually ineffective in stopping or even decreasing the symptoms.

Is MDDS a disability?

The medical definition of disability according to Mosby’s Medical Dictionary is different. It is the loss, absence, or impairment of physical or mental fitness that is observable and measurable. Therein is the difficulty in proving that MDDS qualifies as a disability.

Does exercise help MDDS?

Mal de debarquement exercise and physical therapy seem to help some people with motion-triggered MDDS (about 50%). However, it seems to be less helpful for people with spontaneous MDDS (about 15%). Vestibular rehabilitation seems to help people with motion-triggered MDDS too (about 38%).