Mal de Debarquement - An Illusion of Movement

Introduction:

Mal de debarquement can be defined as an illusion of movement felt as an aftereffect of travel. Sea travel is the most common initiating factor for mal de debarquement syndrome. Patients with mal de debarquement syndrome often complain of a sensation of the uneven ground below their feet while walking or feeling as if they are still on a boat. They rarely experience rotational vertigo or motion sickness. Mal de debarquement syndrome can be either persistent or self-limited. When it is persistent, there may be less possibility of resolution.

What Is Mal de Debarquement Syndrome?

It is a rare and vaguely understood condition of the vestibular system that results in a perception of self-motion such as swaying, rocking, and bobbing. It usually happens after prolonged exposure to motion, like being on a plane or boat. Normally the symptoms last for seconds to three days after prolonged episodes of passive motion. The symptoms may last for weeks, months, or even years. The symptoms may get worse when the person is not moving, like when sleeping or standing still. The common triggering factors include water-based activities like boating and ocean cruising, airplane travel, sleeping over a water bed, and extended landing travel.

What Is the Cause of Mal de Debarquement Syndrome to Occurrence?

The exact cause of mal de debarquement syndrome is still unknown. It is believed that mal de debarquement syndrome can be caused by impairment of vestibulo-ocular reflex (VOR). VOR is a mechanism in the inner ear that maintains balance and stabilizes the eyes during head movements. The body’s balance system is unable to properly process and adapt to multiple sensory inputs such as visual, proprioceptive, vestibular, and cognitive from the environment once the stimulus or trigger has ended. Engaging in sea travel or some other water-related activities is the most frequent trigger for mal de debarquement syndrome. Some less common triggers are traveling by airplane, utilizing virtual reality headsets, strolling on piers, etc.

What Are the Signs and Symptoms of Mal de Debarquement Syndrome?

The signs and symptoms of mal de debarquement syndrome are:

• A persistent sense of motion and rocking and swaying.

• Fatigue.

• Mood changes.

• Confusion.

• Anxiety.

• Depression.

Symptoms get worse with:

• Fast movement.

• Tiredness.

• Being in a closed-in space.

• Stress.

• Enormous visual activity, like playing video games.

• Grocery aisles.

• Flickering lights.

How to Diagnose Mal de Darquement Syndrome?

The diagnosis of mal de Darquement syndrome depends majorly on details of clinical history. The important points are a history of illusory rocking motion following an airplane or boat trip, reduction of symptoms with re-exposure to motion such as when boating or driving, and a relative lack of nausea. The test recommended for a patient complaining of dizziness could be:

• Videonystagmography (VNG): This test evaluates the health of the inner ear and central motor function. It is done to know the root cause of dizziness, vertigo, or balance issues to treat them effectively.

• MRI (magnetic resonance imaging) of the brain.

• CT (computed tomography) scan of the temporal bone.

• Cardiologic evaluation.

• Audiogram.

• Blood tests or laboratory findings.

What Are the Differential Diagnoses of Mal de Debarquement Syndrome?

The differential diagnosis of mal de debarquement includes:

• Vestibular Migraine: Vestibular migraine consists of recurrent vertigo attacks that sometimes can also include headache, phonophobia, photophobia, or aura.

• Chronic Subjective Dizziness: It includes conditions such as panic disorder or anxiety-related dizziness.

• Motion Sickness: This is caused because of vestibular or visual stimulation occurring with motion and symptoms of dizziness, vomiting, nausea, and sweating.

• Benign Paroxysmal Positional Vertigo (BPPV): It is a very common cause of dizziness in elderly people because of the movement of the head. It is believed to be caused as a result of degeneration or injury to the inner ear leading to the clumping of calcium particles together, which otherwise are attached to specific locations within the ear, causing sudden and brief episodes of dizziness.

• Otologic Causes: This rarely causes the unending rocking sensation, which is typical of mal de debarquement syndrome. Meniere’s disease is a condition that includes periodic episodes of vertigo or dizziness, progressive and fluctuating hearing loss, tinnitus, and a sensation of pressure or fullness in the ear. Vestibular neuritis is an inflammatory disease characterized by a single spontaneous attack of vertigo that includes spinning, nausea, and nystagmus.

What Are the Treatment Options for Mal Debarquement Syndrome?

Mal de debarquement usually goes away within a year. It is more common if the patient is young. Mal de barquement syndrome is difficult to treat as no one thing works every time. The treatment options recommended by doctors are :

• Medications: There is no specific drug just for the treatment of mal de debarquement syndrome. However certain medications can be given to treat symptoms such as depression, anxiety, or insomnia that might give some relief to patients. Clonazepam is a preferred drug due to its longer half-life. Anxiolytics and benzodiazepines may help temporarily improve the symptoms. Some doctors have found benefits with selective serotonin reuptake inhibitors as baseline treatment, and benzodiazepines are used only as needed.

• Brain Stimulation Therapy: This is a newer therapy, and it has given promising results in recent studies. This therapy uses electrical signals to activate or inhibit the functioning of the brain. The electricity can be given noninvasively through electrodes placed on the scalp or directly by electrodes implanted in the brain.

• Repetitive Transcranial Magnetic Stimulation: It is a non-invasive and comparatively painless technique that uses magnetic pulses to target specific areas of the brain. It is a form of brain stimulation therapy used to treat depression.

• Vestibular Rehabilitation: Is it an exercise-based program to improve balance and reduce problems due to dizziness? This therapy commonly takes between six and eight weeks. Patients attend the therapy one or two times each week.

• Taking Care: Managing stress, doing regular exercise, and taking proper rest will help in giving some relief to the patient.

What Is the Prognosis of Mal de Barquement Syndrome?

Typically, mal de debarquement syndrome resolves within the initial 24 hours. Without intervention, the majority of individuals show improvement within a year. Yet in uncommon cases, individuals may endure symptoms for months or even years.

Conclusion:

Prevention of mal de debarquement syndrome is not possible in a definitive way. If the person is diagnosed with mal de debarquement syndrome, he or she should stay away from the type of motion that triggers it. If this is not possible, take proper medications in consultation with the doctor. This syndrome is largely unrecognized by many physicians because most of them are unaware of it. Therefore, increased awareness of this syndrome is necessary for timely diagnosis