Mal de Débarquement Syndrome (MdDS)

The most common symptoms of MdDS are persistent sensations of rocking, bobbing, and swaying. Some also experience confusion, balance issues like dizziness, difficulty focusing, and fatigue. In some cases, MdDS can lead to mood changes, anxiety, and depression.

Symptoms of MdDS typically persist for more than 48 hours following a period of travel with prolonged passive motion, such as on a boat or plane. Many experience relief from MdDS symptoms when re-engaging in passive motion such as riding in a car. However, in these cases symptoms typically recur once the passive motion is completed. In some cases, symptoms can worsen following additional passive motion activities.

Mal de débarquement syndrome must be diagnosed clinically, meaning it’s determined by a doctor based on a person’s specific symptoms and medical history. There are currently no specific laboratory tests or biomarkers to diagnose MdDS. This article provides a list of diagnostic criteria often used to determine the presence of MdDS.

While MdDS cannot be identified by medical testing, certain tests can be used to rule out other conditions with similar symptoms, such as vestibular migraine or “land sickness” (temporary unsteadiness or dizziness following persistent motion travel). This process of coming to a diagnosis by eliminating other potential diseases or disorders that could be causing a person’s symptoms is called differential diagnosis. Differential diagnosis of MdDS can include brain imaging scans (like MRIs and CT scans), hearing tests, bloodwork, and balance tests.

Videonystagmography (VNG) is sometimes used as an assessment for MdDS. VNG is a test that measures a type of involuntary eye movement known as nystagmus, which is involved in balance and coordination. This movement is often impacted in cases of MdDS.

Currently, treatment options for MdDS are limited. No single treatment is effective for every case. In some cases, MdDS resolves on its own within a year. Prevention and symptom management for MdDS includes stress management, regular exercise, healthy eating, and rest. 

Clonazepam is an anti-seizure drug that is sometimes effective at low doses in treating symptoms of MdDS. Balance therapy (known as vestibular rehabilitation) is also effective in some cases. Brain stimulation therapy has shown promising results in certain MdDS cases by using electrical signals to alter brain activity.

In the past decade, researchers have made an increased effort to study and understand MdDS, and there are many ongoing efforts to increase awareness and knowledge about this condition. One ongoing MdDS research study seeks to improve symptoms by teaching the vestibular system to adapt. 

Other studies are examining eye movement patterns in people with MdDS. These researchers believe the symptoms of MdDS are caused by difficulties in the vestibulo-ocular reflex (VOR), a mechanism that helps stabilize the eyes while the head is in motion. One team of researchers has developed a technique to re-calibrate the VOR for people with MdDS by combining specific head movements with corresponding movements of a person’s visual surroundings. While this could be the first effective treatment for MdDS, more research is needed.

Additionally, researchers now believe that MdDS can arise spontaneously, without the passive motion triggers once believed to be its sole cause. This understanding led researchers to name two MdDS subtypes, based on what causes the onset of symptoms. 

Motion-triggered MdDS (MT MdDS) is used to describe cases triggered by passive motion events. Non-motion or spontaneous/other MdDS (SO MdDS) occurs in the absence of a triggering event. This type of MdDS may be related to stressful events such as surgeries, traumas, and childbirth.