Note: Some of this information is taken from Dr Timothy Hain's MDD page
What is Mal de Debarquement Syndrome?
Mal de Debarquement Syndrome (or MDDS) is an imbalance or rocking
sensation that occurs after prolonged exposure to motion (most
commonly after a sea cruise or a long airplane flight). Travellers
often experience this sensation temporarily after disembarking, but
in the case of MDDS sufferers it can persist for 6-12 months or even
many years in some cases.
The imbalance is generally not associated with any nausea, nor is it
alleviated by typical motion-sickness drugs such as scopolamine or
meclazine. Symptoms are usually most pronounced when the patient
is sitting still; in fact, the sensations are usually minimized
by actual motion such as walking or driving.
What causes MDDS?
So far, nobody knows the functional cause of
MDDS. From the studies which have been done, it appears
certain that it is not an injury to the ear or brain (vestibular
and CNS tests for MDDS patients invariably turn out normal results).
Speculation about the cause of MDDS includes the following:
- psychiatric condition (particularly linked to depression)
- a hormonal related condition (may occur more often in females)
- otolith organ or central nervous system abnormalities
- some link to a variant of migraine
Whatever the exact reason, MDDS appears to be a failure of the
vestibular system to readapt correctly to stable ground. It has long
been known that the vestibular system adapts to different environments.
In the case of MDDS, it appears that it adapts to the motion
encountered on the boat or plane (i.e. constant rocking or
swaying), and fails to readapt once that stimulus is removed.
How is MDDS diagnosed?
Diagnosis of MDDS is generally a process of
exclusion. As noted in the literature, quantitative vestibular and
neural tests on MDDS sufferers nearly always turn out to be
normal. Diagnosis is usually via a combination of the patient history
(i.e. the sensation arose immediately after prolonged exposure to a
boat or airplane travel), and exclusion of possible alternatives such
as Meniere's disease.
If you feel a constant rocking sensation
which started immediately after a period of prolonged motion
exposure and remains for days, yet everything else appears to be
normal (i.e. you don't have numbness down one side, or hearing
problems etc), then it's possible that you have MDDS.
Note: One source informed me that particular
government organizations may misdiagnose people with MDDS because
MDDS is considered a temporary
condition rather than a permanent condition such as Meniere's. Hence,
this allows patients to be called back at any time for a new physical
and be sent back to work, rather than being treated as a permanent
Treatment for MDDS
The medical literature describes MDDS as a
self-limiting condition. This is medical-speak for saying that
it usually eventually disappears without any direct treatment. It also
means that there is currently no effective method known for curing
In particular, traditional
vertigo-treatment medications that work for other forms of dizziness
or motion sickness appear to have little effect for the MDDS sufferer.
Valium and other derivatives (particularly Klonopin)
have been known to help alleviate some of the severe symptoms in MDDS
patients, but there is always a worry that these are habit-forming and
may prolong the eventual disappearance of the condition.
In general, physical activity is recommended for
vestibular rehabilitation. In particular, physical therapy
has been shown to have success in some patients.
Preventing Occurrences of MDDS
While MDDS usually eventually disappears, it
also more often than not seems to return once a former MDDS sufferer
takes another long boat or plane trip. Hence, preventing MDDS is also
an area of active concern. Once again, possible prevention is largely
speculative, but medications which diminish the response of the
vestibular system may be useful. In particular, Valium and
Ativan have been suggested as pre-trip medications to prevent
reoccurrences of MDDS. In addition, the recently restored availability
of the Transderm patch (active ingredient scopolamine) may be
effective in preventing a recurrence of MDDS while performing any activities
Other conditions which may mimic MDDS
Many vertigo patients report feelings of
unsteadiness, rocking, or dizziness. Although all of these symptoms are
symptoms of MDDS, oftentimes, the condition is something more common
than the very rare MDDS.
One such condition is Benign Paroxsysmal
Positional Vertigo (BPPV). While BPPV does involve sensations of
dizziness, it is usually characterized as being brought on suddenly
when the patient changes the location of their head (e.g. getting up
out of bed, getting our of a chair, bending down, lying down in bed).
Usually, the attack will lead to the patient experiencing severe
vertigo and nystagmus (eye-movement) which usually lasts no more than
a minute or two. This is in contrast to the normal pattern of MDDS
which is that patients experience symptoms constantly, regardless of
the way their head is located, and seldom involves sudden losses of
balance or abnormal eye movement.
You can read more about BPPV and a very
effective (over 90%) non-surgical procedure to treat it on this BPPV/CRP web
Another condition that may sometimes seem
similar to MDDS is Meniere's Disease. This condition also
causes general unsteadiness, but like BPPV, it is most often
characterized by severe attacks sometimes called drop attacks
because the patient will fall to the ground with a fit of nausea.
Caused by a build up of pressure inside the ear, this condition is
treatable with drugs and diet.
For more information, visit this
Meniere's Disease web
- Hain, T.C., Hanna, Philip A., Rheinberger, Mary A.: Mal
de Debarquement. Archives of Otolaryngology - Head & Neck Surgery
- Brown, J.J., and Baloh, R.W.: Persistent Mal de Debarquement syndrome:
A motion-induced subjective disorder of balance. American
Journal of Otolaryngology, 1987;8:219-22
- Furman, J.: Mal de Debarquement Syndrome Case History Balance
Disorders, 1996, 306-308
- Mair, I.W.S.: The Mal de Debarquement Syndrome Journal of
Audiological Medicine, 1996;5:21-25
- Murphy, T.P.: Mal de Debarquement syndrome: A forgotten
entity? Otolaryngology - Head and Neck Surgery, 109:10-13, 1993
MDDS support site designed by Evan Torrie
Copyright 1997, Evan Torrie