Treatment of the Mal de Debarquement Syndrome: A 1-Year Follow-up

Abstract

The mal de debarquement syndrome (MdDS) is a movement disorder, occurring predominantly in women, is most often induced by passive transport on water or in the air (classic MdDS), or can occur spontaneously. MdDS likely originates in the vestibular system and is unfamiliar to many physicians. The first successful treatment was devised by Dai et al. (1), and over 330 MdDS patients have now been treated. Here, we report the outcomes of 141 patients (122 females and 19 males) treated 1 year or more ago. We examine the patient's rocking frequency, body drifting, and nystagmus. The patients are then treated according to these findings for 4-5 days. During treatment, patients' heads were rolled while watching a rotating full-field visual surround (1). Their symptom severity after the initial treatment and at the follow-up was assessed using a subjective 10-point scale. Objective measures, taken before and at the end of the week of treatment, included static posturography. Significant improvement was a reduction in symptom severity by more than 50%. Objective measures were not possible during the follow-up because of the wide geographic distribution of the patients. The treatment group consisted of 120 classic and 21 spontaneous MdDS patients. The initial rate of significant improvement after a week of treatment was 78% in classic and 48% in spontaneous patients. One year later, significant improvement was maintained in 52% of classic and 48% of spontaneous subjects. There was complete remission of symptoms in 27% (32) of classic and 19% (4) of spontaneous patients. Although about half of them did not achieve a 50% improvement, most reported fewer and milder symptoms than before. The success of the treatment was generally inversely correlated with the duration of the MdDS symptoms and with the patients' ages. Prolonged travel by air or car on the way home most likely contributed to the symptomatic reversion from the initial successful treatment. Our results indicate that early diagnosis and treatment can significantly improve results, and the prevention of symptomatic reversion will increase the long-term benefit in this disabling disorder.

Keywords: adaptation; bobbing; disembarking syndrome; rocking; sea legs; swaying; velocity storage; vestibular.

Figure 1

Scores (A) and posturography (B–D) in all patients with ≥50% self-scored improvement. (A) Histogram of self-scores (median = 75%). (B) Histogram of improvement in postural sway (median = 63%). (C) Histogram of improvement in rocking (median = 55%). (D) Histogram of the total trajectory length (maximum excursion) of the center-of-pressure (COP) deviation (median = 38%). (E1) Example of pretreatment sway with a dominant frequency of 0.2 Hz. (E2) Pretreatment rocking with a frequency of 0.2 Hz. (F1) Posttreatment sway with no specific frequency. (F2) Posttreatment rock. (G) Pretreatment trajectory of COP. (H) Posttreatment trajectory of COP.

Figure 2

Percentage of patients improved at week 1, week 2, month 3, month 6, and month 12 after treatment.

Figure 3

Improvement rates in female and male patients at week 1, week 2, month 3, month 6, and month 12 after treatment.

Figure 4

The relationship between the rate of success and the duration of mal de debarquement syndrome at week 1, week 2, month 3, month 6, and month 12 after treatment.

Figure 5

(A) Age distribution of patients with classic mal de debarquement syndrome (mean 48 ± 14 years). (B) The success rate of the three groups over a year.

Figure 6

Progression in severity scores over a year in treatment-successful and treatment-unsuccessful groups. Time 0 is pretreatment, followed by posttreatments at week 1, week 2, month 3, month 6, and month 12. The symptom rebound at week 2 is indicated by arrows. The SDs of the data set were not shown, which are from 1.0 to 2.0.