NORD gratefully acknowledges the Vestibular Disorders Association and Jeffrey Kramer, MD, Neurology Department, Mercy Hospital and Medical Center, Chicago, IL, for assistance in the preparation of this report.
Mal de debarquement (MDD) is a rare and poorly understood disorder of the vestibular system that results in a phantom perception of self- motion typically described as rocking, bobbing or swaying. The symptoms tend to be exacerbated when a patient is not moving, for example, when sleeping or standing still. Studies have shown that a brief period of these symptoms is common in healthy individuals after prolonged episodes of passive motion, normally lasting seconds to three days. However, in MDD, significant balance impairment can persist for months to years. Symptoms may diminish in time or may reappear spontaneously or after another exposure. The most common triggers are water-based activities such as ocean cruising. Less common triggers include airplane travel, extended landing travel and sleeping on water beds. Other common complaints of patients with MDD include a sensation of uneven ground below their feet while walking, or feeling as if they are still on a boat. It is rare for MDD patients to have true rotational vertigo or motion sickness.
The primary symptom is the persistence of a sense of motion and rocking. Some patients may experience fatigue, mood changes and confusion. Imbalance is a common complaint. Symptoms often increase when exposed to fast movements, flickering lights and grocery store aisles. There may be transient improvement in symptoms with re-exposure to passive motion, for example, riding in cars or trains. After completion of the trip, however, the symptoms tend to recur.
Studies have shown that the length of time one is exposed to a motion experience does not determine the severity or duration of the syndrome, but most typical cases are triggered by day trips lasting several days.
The true cause behind MDD is still unknown. MDD likely results from the body’s balance system inadequately processing and adapting to multiple sensory inputs (visual, vestibular, proprioceptive and cognitive) from the environment once the stimulus (trigger) has ended. It is as yet undetermined as to the cause of the balance system’s inability to appropriately compensate and adapt. How or why this happens remains a mystery.
The majority of people affected are adult females, although there have been reports of males having the diagnosis. Patients with migraine may have any increased susceptibility through unknown mechanisms.
The diagnosis of MDD still remains mostly clinical. As such, the history is very important. Persistent “dizziness” after an ocean cruise, a sailing trip, a prolonged airplane flight or a cross-country road trip is highly suggestive of MDD. Vestibular function tests in patients with MDD have been normal or nonspecific in their abnormality. These tests are important in excluding other etiologies for the patient’s symptoms.
MDD is very difficult to treat, with little effectiveness of most treatments. Clonazepam at low doses once or twice a day has shown improvement in patients. Higher doses were not proven to be effective. Vestibular rehabilitation has shown effectiveness in a small number of patients.
A small study from Dai et, al. (see References below) reported that using a full-field visual stimulus while the head was rolled resulted in >50% improvement in both subjective and objective symptoms. These findings are encouraging but need to be reproduced. Patients who do recover may be susceptible to recurrences of increased duration.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov . All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
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For information about clinical trials sponsored by private sources, contact: www.centerwatch.com
Some current clinical trials also are posted on the following page on the NORD website:
For more information about clinical trials conducted in Europe, contact: https://www.clinicaltrialsregister.eu/
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 May 5;8:175. https://pubmed.ncbi.nlm.nih.gov/28529496/
Ghavami Y, Haidar YM, Ziai KN, Moshtaghi O, Bhatt J, Lin HW, Djalilian HR. Management of mal de debarquement syndrome as vestibular migraines. Laryngoscope. 2016 Oct 12. www.ncbi.nlm.nih.gov/pubmed/27730651
Hain TC, Cherchi M. Mal de debarquement syndrome. Handb Clin Neurol. 2016; 137:391-5. www.ncbi.nlm.nih.gov/pubmed/27638086
Cha YH, Urbano D, Pariseau N. Randomized Single Blind Sham Controlled Trial of Adjunctive Home-Based tDCS after rTMS for Mal De Debarquement Syndrome: Safety, Efficacy, and Participant Satisfaction Assessment. Brain Stimul. 2016 July-Aug; 9 (4):537-44. www.ncbi.nlm.nih.gov/pubmed/27117283
Van Ombergen A, Van Rompaey V, Maes L, Van de Heyning P, Wuyts F. Mal de debarquement syndrome: a systematic review. J Neurol. 2016: 263: 843-854. www.ncbi.nlm.nih.gov/pmc/articles/PMC4859840
Teitelbaum P. Mal de debarquement syndrome: a case report. J Travel Med. 2002;9:51-52.
Gordon CR, Shupak A, Nachum Z. Mal de debarquement. Arch Otolaryngol Head Neck Surg. 2000;126:805-06.
Hain TC, Hanna PA, Rheinberger MA. Mal de debarquement. Arch Otolaryngol Head Neck Surg. 1999;125:615-20.
Cohen H. Mild mal de debarquement after sailing. Ann NY Acad Sci. 1996;19:781;598-60.
Gordon CR, Spitzer O, Doweck I, et al. Clinical features of mal de debarquement: adaptation and habituation to sea conditions. J Vestib Res. 1995;5:363-69.
Murphy TP. Mal de debarquement syndrome: a forgotten entity: Otolaryngol Head Neck Surg. 1993;109:10-13.
Gordon CR, Spitzer, Shupak A, et al. Survey of mal de debarquement. BMJ. 1992;304:544.
Haybach PJ and Kinne B. Mal de Debarquement. Vestibular Disorders Association. 2014. http://vestibular.org/mal-de-d%C3%A9barquement. Accessed June 2, 2020.
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