NORD gratefully acknowledges Timothy C. Hain, MD, Professor of Neurology, Orolaryngology, and Physical Therapy/Human Movement Science at Northwestern University, for assistance in the preparation of this report.
Mal de debarquement syndrome (MdDS) is a rare and little understood disorder of the body’s balance system (vestibular system) and refers to the rocking sensation and/or sense of imbalance that persists for an excessive length of time after an ocean cruise, plane flight or other motion experience. Most people after exposure to an ocean trip or long airplane ride will experience "motion" after the event is over and for a short period of time, with two days being the upper limit of normal. But for persons with MdDS, these sensations may last for 1 month or a year or even many years. Symptoms may diminish in time or periodically disappear and reappear after days, months, or years, sometimes after another motion experience or sometimes spontaneously. This syndrome is probably more common than the literature might lead us to believe, as the level of awareness in the general population as well as among health personnel is very low.
The disproportionate length of time over which the discomfort persists is normally unaccompanied by nausea, nor is it responsive to motion-sickness drugs.
For reasons that are not understood, middle aged women are overwhelmingly more likely to come down with MdDS than are men. However, most studies so far have disavowed hormones as a cause.
The primary symptom is the persistence of the sense of motion and rocking for an inordinate length of time after the trip is over. In addition to the persistence of rocking, patients may experience fatigue, confusion, or a feeling of heaviness. Symptoms often increase while the individual is maneuvering in narrow aisles or observing fast movements or flickering lights. Patients usually report that the symptoms are most bearable while driving or riding in an auto, but symptoms reoccur soon after completing the trip. Other reported symptoms include migraine headaches, ringing in the ears (tinnitus), ear fullness, ataxia and depression following stress.
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 boat trips lasting several days.
It is likely that MdDS is the result of a failure of the body’s balance system to readapt to the environment even after the stimulus is ended. It is much more difficult to understand the cause of the balancing system’s failure to readapt. Neurological tests of patients with MdDS fail to detect any distinction between them and control subjects. That is, MdDS patients test normal.
Prevailing opinions concerning the cause of MdDS include the following: a failure of the brain to readapt to solid ground after a motion experience, migraine headaches linked via an unknown mediator or unknown factors within the vestibular system.
People who come down with MdDS are overwhelmingly female adults although males have also been diagnosed.
The diagnosis of MDDs is based principally upon the exclusion of reasonable alternatives such as those described above. A persistent dizziness after a sea voyage, a sailing trip, a long airplane flight or even a road trip is enough to merit the suspicion of mal de debarquement. A patient’s feelings of relief while driving or riding in an auto are other clues. In order to exclude other causes of dizziness, other test may be performed. Such tests will probably include, but may not be limited to, evaluation of hearing, rotary chair testing to evaluate the vestibular ocular reflex, electronystagmography to assess the system of semicircular canals in the ear, assessment of vestibular function to check the capacity to maintain balance.
Most drugs that work for other forms of dizziness do not work on MdDS. Medications that reduce nerve irritability such as Dilantin do not appear to work, either. Those medications most frequently prescribed fall into the vestibular suppressants category, including antidepressants or anti-seizure medications. Customized vestibular therapy or various exercise routines are effective in some cases, but no controlled study has been performed that proves that they work.
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
TTY: (866) 411-1010
For information about clinical trials sponsored by private sources, contact:
Contact for additional information about mal de debarquement syndrome:
Timothy C. Hain, MD
Professor of Neurology, Orolaryngology, and
Physical Therapy/Human Movement Science
Chicago, IL 60611
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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.
Mal de debarquement. http://vestibular.org/mal-de-d%C3%A9barquement. Accessed June 1, 2012.
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