Mal de Debarquement syndrome

Mal de Debarquement -Update

This post will be an update of two previous posts regarding Mal de Debarquement syndrome (MDD). This is prompted by a recent visit from a patient that had already been diagnosed with MDD, but came to us wanting to know the latest information regarding treatment. We see only a few patients a year meeting the diagnostic criteria for MDD, so I needed to do a little research to make sure I was current.

Up until a few years ago, the conventional wisdom was that there was no effective treatment for MDD, and that in the vast majority of cases, the symptoms gradually resolved.

 

Mal de Debarquement Syndrome

In 2015, I reported on a novel treatment developed at Mount Sinai Hospital in New York City. The results reported were impressive. Over the past few years, I have relayed this information to MDD patients as a last resort if their symptoms did not resolve. We had one patient travel to New York for the treatment. Her anecdotal report was that, after three years of symptoms she was notably better after the four day treatment regimen. I remember her telling me that she actually enjoyed walking around Times Square.

There have been two updates by the same Mount Sinai group. The first is a report of one year follow up on patients treated for MDD in their clinic. They break there patient down into two main groups: Classic –patients that experienced the typical symptoms of MDD following exposure to prolonged motion, such as a ship; and Spontaneous –similar symptoms but with no obvious triggering event. While they had impressive results in reducing and resolving symptoms in both groups, there was a significant re-emergence of symptoms at one year follow up. The authors suspect that a pertinent factor relates to the fact that many of these patients traveled a distance to New York City for the treatment, therefore, were subjected to extended travel (a trigger for the symptoms) shortly after successful treatment.

“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”.

 

For those readers interested in delving deeper into the mystery of MDD, some of the researchers published an article just a few months ago hypothesizing the basis of these symptoms. It is very detailed, and assumes some prior knowledge of the vestibular-Ocular Reflex and its neural projections. It is not light reading.

 

*featured image courtesy wikimedia commons

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About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.

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