Treatment of Mal de Debarquement Syndrome in an Audiology-Vestibular Clinic

Abstract

Background Mal de Debarquement Syndrome (MdDS) has a stereotypical presentation of symptoms including continuous rocking/swaying sensations described as feeling like one is “still on the boat,” following travel, especially on water vessels. MdDS is even more notorious for the duration of symptoms that can persist months or years, and historically this condition has escaped effective treatments.

Purpose This case study presents a case of classic MdDS that was effectively treated in an Audiology-Vestibular clinic. Treatment consisted of three, relatively short-lived vestibular rehabilitation sessions using the “Roll Readaptation” technique that has previously been reported in Neurology journals.

Study Sample The study sample includes a 48-year-old female with a history of MdDS following two separate ocean cruises. She underwent vestibular evaluation and was treated with a treatment paradigm aimed to readapt the central vestibular system and vestibular-ocular reflex.

Results This report focuses on a brief review of current symptomology and diagnostic criteria of MdDS, underlying pathophysiology and application of a relatively new treatment technique in an audiology clinic. This patient was shown full-field, omni-directional optokinetic (OPK) stimulus while rolling her head rhythmically for up to 4 minutes at a time. After three treatment sessions, the patient had a significant reduction in subjective symptoms and returned to full-time work. She had previously been off work for nearly 3 months.

Conclusion Individuals with MdDS suffer large daily and work life disruptions due to the persistent nature of symptoms, and their physical manifestations. In addition, they have historically had minimal treatment options. This case demonstrates that audiologists with proper equipment may have the potential to readily offer treatment for a previously “untreatable” condition.

Keywords

Mal de Debarquement Syndrome - vestibular rehabilitation - optokinetic - Roll Readaptation

Publication History

Received: 24 September 2020

Accepted: 12 March 2021

Article published online:
02 November 2022

• References

• 1 Darwin E. Zoonomia. London: J. Johnson; 1796
• 2 Cha YH, Baloh RW, Cho C. et al. Mal de Débarquement Syndrome diagnostic criteria: Consensus document of the Classification Committee of the Bárány Society. J Vestib Res 2020; 30 (05) 285-293
• 3 Cohen B, Yakushin SB, Cho C. Hypothesis: the vestibular and cerebellar basis of the Mal de Debarquement Syndrome. Front Neurol 2018; 9: 28
• 4 Mucci V, Canceri JM, Brown R. et al. Mal de Debarquement Syndrome: a survey on subtypes, misdiagnoses, onset and associated psychological features. J Neurol 2018; 265 (03) 486-499
• 5 Dai M, Cohen B, Smouha E, Cho C. Readaptation of the vestibulo-ocular reflex relieves the Mal de Debarquement Syndrome. Front Neurol 2014; 5: 124
• 6 Gordon CR, Spitzer O, Shupak A, Doweck I. Survey of Mal de Debarquement. BMJ 1992; 304 (6826): 544
• 7 Dai M, Cohen B, Cho C, Shin S, Yakushin SB. Treatment of the Mal de Debarquement Syndrome: a 1-year follow-up. Front Neurol 2017; 8: 175
• 8 Mucci V, Perkisas T, Jillings SD. et al. Sham-controlled study of optokinetic stimuli as treatment for Mal de Debarquement Syndrome. Front Neurol 2018; 9: 887
• 9 Hain TC, Hanna PA, Rheinberger MA. Mal de Debarquement. Arch Otolaryngol Head Neck Surg 1999; 125 (06) 615-620
• 10 Cha YH, Deblieck C, Wu AD. Double-blind sham-controlled cross-over trial of repetitive transcranial magnetic stimulation for Mal de Debarquement Syndrome. Otol Neurotol 2016; 37 (06) 805-812
• 11 Cha YH, Cui Y, Baloh RW. Repetitive transcranial magnetic stimulation for Mal de Debarquement Syndrome. Otol Neurotol 2013; 34 (01) 175-179
• 12 Yakushin SB, Raphan T, Cohen B. Coding of velocity storage in the vestibular nuclei. Front Neurol 2017; 8: 386
• 13 Liphart J. Use of sensory reweighting for a woman with persistent Mal de Debarquement: a case report. J Geriatr Phys Ther 2015; 38 (02) 96-103
• 14 Ghavami Y, Haidar YM, Ziai KN. et al. Management of Mal de Debarquement Syndrome as vestibular migraines. Laryngoscope 2017; 127 (07) 1670-1675