Mal de Debarquement Syndrome
Mal de Debarquement syndrome (MdBS) which translates to mean “sickness after disembarkment”, refers to sensations of self-movement after exposure to passive motion. MdBS typically follows a sea voyage, but similar sensations have been described following prolonged train or air travel, and even space flight. Considering this syndrome was first recognized in 1987 by Brown and Baloh, and because it is considered quite a rare disease, the underlying pathogenesis of MdBS has only been demonstrated recently. According to a neuroimaging study by Cha and colleagues (2012) using functional MRI, there was an increase in metabolic properties (hypermetabolism) in MdBS patients, compared to their healthy counterparts, in the entrorhinal cortex-amygdala and the visual and vestibular processing areas.
In any case, patients are diagnosed with either Transient MdBS (where symptoms last under 48 hours), Prolonged MdBS (symptoms lasting between 48 hours and 1 month) and Persistent MdBS (symptoms lasting longer than 1 month). The syndrome predominantly affects women (Hain et al. 1999), with a mean age of 52 years (Arroll et al.; 2014), and an average duration of symptoms lasting for 3.5 to 5 years. The most common reported symptoms include rocking, swaying, unsteadiness and disequilibrium, as well as, tinnitus, ear fullness, ear ache or hearing loss. Aggravating factors may include further motion exposure (i.e.; flights, car rides, boat rides, etc), increased anxiety, increased stress, positional changes, rapid head movements, and large crowds (i.e.; malls). Factors that a patient may report that alleviate their MdBS symptoms include remaining in activities of motion (i.e.; driving).
Given the fact that there is a strong predominance of women in studies of MdBS from a relatively narrow age group, many studies would suggest that there may be some association between the syndrome and female hormones. Hain and colleagues (1999) found that 80 percent of female subjects were either premenopausal or receiving hormone replacement therapy.
A systematic review by Ombergen and colleagues (2016), demonstrates that because this syndrome is fairly rare and relatively new, the treatment options are limited. Benefits have been noted with vestibular rehabilitation therapy, pharmaceutical agents (i.e.; benzodiazepines, selective serotonin reuptake inhibitors), stress relievement therapy, and more recently modulation of the vestibule-ocular reflex and neuromodulation through repetitive transcranial magnetic stimulation (rTMS) .
A retrospective study looked at the socio-economic burden of the syndrome. MacKe and colleagues (2012) reported that patients averaged 19 visits to a healthcare professional before receiving a proper MdBS diagnosis, hovering around $2,997 in direct health care costs per patient. A large majority of these subjects were also incapacitated and could not work, adding indirect costs to the syndrome.
- Arroll M, Attree E, Cha Y, Dancey C (2014). The relationship between symptom severity, stigma, illness intrusiveness and depression in Mal de Debarquement Syndrome. J Heal, Phsychol.
- Brown J, Baloh R (1987). Persistent mal de debarquement syndrome: a motion-induced subjective disorder of balance. Am J Otolaryngol 8 (4): 219-222.
- Cha Y, Chakrapani S, Craig A, Baloh R (2012). Metabolic and functional connectivity changes in Mal de Debarquement syndrome. PLoS One 7:e49560.
- Hain T, Hanna P, Rheinberger M (1999). Mal de debarquement. Arch Otolaryngol Head Neck Surg 125 (6): 615-620.
- Ombergen A, Rompaey V, Maes L, Van de Heyning P, Wuyts F (2016). Mal de debarquement syndrome: a systematic review. J Neurol 263: 843-854.
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