Mal de Debarquement Syndrome

Last week, I posted a question from a young lady from Idaho that experienced “dizziness” and decreased balance following a night of watching fireworks from a boat over the fourth of July last year. She suspected it may have been the result of the loud fireworks. I suspect (as did a non-professional commenter) that it was more likely the boat. The hint I gave last week was pretty easy to figure out. The answer to the question is obviously the French. But what does that have to do with poor balance?

The literal translation of the French term “Mal de Debarquement” means “sickness of disembarkment.” Mal de Debarquement has been defined as “phantom self motion perception that occurs after exposure to passive motion” ^[1].

In this poorly understood phenomenon, patients experience a persistent rocking sensation after spending time exposed to persistent motion. Most often, MDD occurs following a boat trip, but there are reports of MDD occurring after a flight, long car ride and even sleeping on a waterbed ^[1] . It is speculated that these patients have undergone some type of adaptation to prolonged passive motion such as the to-and-fro motion of a ship, and have difficulty readapting to solid earth. There is no evidence to suggest that MDD represents a peripheral vestibular disorder, but rather, it most likely represents a “disorder of neuroplasticity”^[1] . Mal de debarquement syndrome is overwhelmingly more prevalent in females.

Common complaints suggestive of MDD include:

“I feel like I am still on the boat”

“I feel like I am rocking, swaying ever since I got off the boat.”

“ I can’t stand being where things are moving around me”

“I feel better when I am moving in the car/back on the boat.”

A brief duration of symptoms associated with MDD is not unusual, being reported in 40% to 70% of boat passengers ^[2]. Complete resolution of symptoms with a few days is the norm. A very small percentage of patients have symptoms that persist for months to years. Interestingly, many MDD patients experience some temporary relief when re-exposed to the passive motion (e.g. getting back on the boat), but may experience an exacerbation of symptoms upon returning to solid ground.

Next week we return to our series on treatments for Meniere’s disease.