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Current Knowledge 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 condition. 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 MDDS. 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 involving motion. 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 page. 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 page. References 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