Readaptation Treatment of Mal de Debarquement Syndrome With a Virtual Reality App: A Pilot Study

Abstract

Mal de Debarquement syndrome (MdDS) is composed of constant phantom sensations of motion, which are frequently accompanied by increased sensitivity to light, inability to walk on a patterned floor, the sensation of ear fullness, head pressure, anxiety, and depression. This disabling condition generally occurs in premenopausal women within 2 days after prolonged passive motion (e.g., travel on a cruise ship, plane, or in a car). It has been previously hypothesized that MdDS is the result of maladaptive changes in the polysynaptic vestibulo-ocular reflex (VOR) pathway called velocity storage. Past research indicates that full-field optokinetic stimulation is an optimal way to activate velocity storage. Unfortunately, such devices are typically bulky and not commonly available. We questioned whether virtual reality (VR) goggles with a restricted visual field could effectively simulate a laboratory environment for MdDS treatment. A stripes program for optokinetic stimulation was implemented using Google Daydream Viewer. Five female patients (42 ± 10 years; range 26-50), whose average MdDS symptom duration was 2 months, participated in this study. Four patients had symptoms triggered by prolonged passive motion, and in one, symptoms spontaneously occurred. Symptom severity was self-scored by patients on a scale of 0-10, where 0 is no symptoms at all and 10 is the strongest symptoms that the patient could imagine. Static posturography was obtained to determine objective changes in body motion. The treatment was considered effective if the patient's subjective score improved by at least 50%. All five patients reported immediate improvement. On 2-month follow-ups, symptoms returned only in one patient. These data provide proof of concept for the limited-visual-field goggles potentially having clinical utility as a substitute for full-field optokinetic stimulation in treating patients with MdDS in clinics or via telemedicine.

Keywords: Mal de Debarquement syndrome; bobbing; readaptation; rocking; swaying; velocity storage.

Figure 1

Overall symptom severity self-scores before and after readaptation treatment in five patients. (A–E) Scores after individual treatments in each patient. (F) Overall symptoms score obtained before, after and on follow-ups.

Figure 2

The static post-urography obtained from patient VGR018 standing with feet apart and eyes closed over 15 s. (A) Swaying. (B) Rocking (black trace, prior to treatment; blue, after treatment 1; red, after treatment 2). (C–E) X–Y plot of posture obtained prior to treatment (C) and after head motion side-to-side at 0.2 Hz for 2 min (D) and at 0.1 Hz for 3 min (E).

Figure 3

The treatment of gravitational pull-back sensations. Patient VRG017 had experienced gravitational pull back. (A) Swaying and (B) rocking during treatment. Resistance to pull back on the trace looks like body rocking at 0.2 Hz with constant body drift backward. (C–E) X-Y plot of posture obtained prior to treatment (C), after two treatments with upward OKN for 4 min (D) and 5 min (E), respectively.