Mal de debarquement

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Mal de debarquement (or Mal de débarquement) syndrome (MdDS, or disembarkment syndrome) is a rare condition usually occurring after a cruise, aircraft flight, or other sustained motion event. It has only recently received attention and very little scientific research has been conducted. The phrase "mal de débarquement" is French for "disembarkation sickness".

Symptoms[edit]

Symptoms most frequently reported include a persistent sensation of motion usually described as rocking, swaying, or bobbing; difficulty maintaining balance; extreme fatigue; and difficulty concentrating ("brain fog"). Other common symptoms include dizziness, visual disturbances (such as seeing motion, inability to focus etc.), headaches and/or migraine headaches, confusion, and anxiety. Many patients also describe ear symptoms such as hyperacusis, tinnitus, "fullness", pain, or even decreased hearing. Cognitive impairment ("brain fog") includes an inability to recall words, short term memory loss, and an inability to multi-task.

Interestingly, the condition often abates when the patient is in motion such as in a car, train, plane, or boat. Symptoms are increased by stress, lack of sleep, crowds, flickering lights, loud sounds, fast or sudden movements, enclosed areas or busy patterns.

In MdDS, the symptoms persist for more than a month, possibly for many years, and sometimes do not resolve at all. This differs from the very common condition of "land sickness" that most people feel for a short time after a motion event such as a boat cruise, aircraft ride, or even a treadmill routine.

MdDS is thought to be a neurological syndrome with no known cause or cure. Research is being undertaken into the neurological nature of this syndrome through imaging studies.

Epidemiology[edit]

The condition is thought to be under-reported in the medical literature, where fewer than 100 cases have been studied. A series of 27 cases reported in 1999 noted all but one patient to be female. The average age in this series was 49 years.[1]

These trends have recently been confirmed by the MdDS Balance Disorder Foundation[2] in a study of over 100 individuals diagnosed with MdDS. The female:male ratio was approximately 9:1; the average age of onset was 43–45 years.

It has been shown to occur in excursions of as little as five hours though it has been unclear how long it takes for symptoms to occur.[3] The most commonly reported inciting event was a prolonged ocean cruise (~45%), however shorter boating excursions (~22%), aircraft travel (~15%), and automobile travel (~8%) have all been described.

Diagnosis[edit]

MdDS is a diagnosis of exclusion.[3] There are no definitive tests that confirm MdDS, only tests that rule out other conditions.[3]

Treatment[edit]

There is no known cure for the condition. In the series cited above, more than 50% of patients had resolution of symptoms within three years of onset. For most balance and gait disorders, some form of displacement exercise is thought helpful (for example walking, jogging, or bicycling but not on a treadmill or stationary bicycle). This has not been well-studied in MdDS however. Medications that suppress the nerves and brain circuits involved in balance (the benzodiazepine clonazepam for example) have been noted to help, but don't seem to offer a permanent cure. It is not known whether medication that suppress symptoms prolong symptom-duration or not.

See also[edit]

References[edit]

  1. ^ Hain TC, Hanna PA, Rheinberger MA. (Jun 1999), "Mal de debarquement", Archives of Otolaryngology - Head & Neck Surgery 125 (6): 615–20, doi:10.1001/archotol.125.6.615, PMID 10367916 
  2. ^ "Understanding Mal de Débarquement Syndrome". MdDS Balance Disorder Foundation. Retrieved 2013-05-14. 
  3. ^ a b c Gibbs CR, Commons KH, Brown LH, Blake DF (December 2010). "'Sea legs': sharpened Romberg test after three days on a live-aboard dive boat". Diving and Hyperbaric Medicine : the Journal of the South Pacific Underwater Medicine Society 40 (4): 189–94. PMID 23111933. Retrieved 2013-05-14. 

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