TürkçeMal de Débarquement Syndrome (MdDS) is a rare balance disorder characterized by a sensation of rocking on land after sea travel or prolonged motion. Even when the person is motionless, sensations of rocking, swaying, and imbalance continue. This condition seriously affects quality of life.
Prominent symptoms of MdDS include a persistent rocking sensation, dizziness, difficulty concentrating, and fatigue. Although complaints usually begin after travel, they may sometimes arise spontaneously. Symptoms may continue for days or even months.
The causes of MdDS are not fully known, but it is thought to be associated with disturbances in the adaptation process of the vestibular system. This syndrome, which is more common in women, may also be influenced by hormonal factors and a predisposition to migraine.
Vestibular rehabilitation, medication therapy, and lifestyle adjustments are used in the treatment of MdDS. While balance exercises are beneficial for some patients, neurological treatment methods are preferred in others to relieve symptoms.
What Are the Causes of Mal de Débarquement Syndrome?
The cause of Mal de Débarquement Syndrome is prolonged exposure to passive motion. Primarily, after prolonged passive motion, the brain is unable to reverse the changes in the way it processes movement. Therefore, when the motion ends, sensations of rocking and lightheadedness may occur.
Another notable factor is disruption of the vestibulo-ocular reflex. This means that the systems that play an important role in maintaining balance and spatial orientation fail to recalibrate. Failure in these systems arises particularly from ongoing abnormal activity in the cerebellum and vestibular nuclei.
Studies have used various neuroimaging techniques to investigate the causes of this disorder.
- Functional imaging has documented increased activity, particularly in the left entorhinal cortex and amygdala regions.
- Activity in these regions shows abnormal connections with sensory processing areas and reduced connectivity between the frontal and temporal cortices.
Another factor involves theories based on neuroplasticity.
- When the brain is continuously exposed to oscillating motion, it adapts to these movements in a pathological manner.
- Accordingly, the temporary relief of symptoms when exposed again to similar motion reveals the brain’s dependence on this maladaptive movement pattern.
Hormonal changes are also among the causes of MdDS.
- Hormonal fluctuations observed particularly in perimenopausal women may trigger the effects of the neuromodulator Calcitonin Gene-Related Peptide.
- This peptide increases neural maladaptation and causes MdDS symptoms to persist.
How Common Is Mal de Débarquement Syndrome?
Mal de Débarquement Syndrome is more common among women than men. The ratio is eight women to two men. MdDS is a type of neurological disorder, and its sex-specific distribution is generally associated with gonadal hormones.
MdDS can occur in all individuals who use air, sea, or land transportation. The main triggers are generally exposures such as long sea journeys, long flights, and repeatedly using different rides at amusement parks. It is characterized by an inability to readapt to land after travel, along with sensations of rocking and imbalance. When taking the patient’s history, this trigger is clearly identified in the vast majority of cases.
Spontaneous-Onset Mal de Débarquement Syndrome describes cases that occur without exposure to motion. This group represents a smaller percentage and may be triggered by stress, hormonal fluctuations, and other factors unrelated to motion. In brief, it may be triggered by factors such as:
- Stress
- Hormonal changes
- Other factors unrelated to motion
The age of onset is generally in the fourth to fifth decades of life. On average, it occurs between the ages of 43 and 52. The sensation of movement may continue for months or even years, causing serious physical and psychological effects in individuals.
The prevalence of Mal de Débarquement Syndrome is not known precisely because underdiagnosis and misdiagnosis are quite common. A very small percentage of patients seen in neurology or ENT clinics receive this diagnosis, and this rate is approximately 1.3%. Identifying and diagnosing the disease may be difficult because Spontaneous-Onset cases can be confused with other conditions such as Persistent Postural-Perceptual Dizziness (PPPD). A large proportion of individuals with MdDS experience migraine, affecting 23% to 38% of patients. The role of hormonal fluctuations is particularly noteworthy, as many women report worsening symptoms during perimenstrual periods.
What Are the Symptoms of Mal de Débarquement Syndrome?
Mal de Débarquement Syndrome is a condition that creates a sensation of movement even while motionless. It generally occurs after a boat trip, and individuals feel as though they are in a swaying environment. Symptoms usually increase while motionless and may worsen while working in static environments. Conditions such as stress and fatigue also cause symptoms to flare up.
Symptoms include:
- Oscillating vertigo: A constant sensation of movement is experienced even while motionless.
- Improvement with passive motion: Symptoms may temporarily decrease when exposed to passive motion, such as traveling in a car or boat.
- Exacerbation without motion: Symptoms may become more noticeable in static situations.
- Associated migraine: Migraine may occur more frequently together with motion-related symptoms.
- Cognitive difficulties: Difficulties with memory, concentration, and general cognitive functioning may occur.
- Other symptoms: Anxiety, depression, sleep disorders, and sensitivity to light are also included.
How Is Mal de Débarquement Syndrome Diagnosed?
Mal de Débarquement Syndrome is generally diagnosed through clinical evaluation. The patient’s history requires a detailed analysis of symptoms. Patients typically report a prolonged sensation of swaying and rocking. These symptoms are generally more pronounced when they are motionless and may improve with movement. Vestibular examinations must be performed to exclude other possible causes.
Basic Steps in Diagnosis:
- A detailed patient history is taken, particularly including the onset of symptoms after passive motion.
- The duration and severity of symptoms are evaluated.
- Motion-triggered and non-motion-triggered forms are distinguished.
- VNG, v-HIT, and, if possible, VEMP are recommended.
Although MdDS is a different variant of motion sickness, nausea and vomiting are not prominent.
Although the worsening of symptoms in static positions and relief during motion is a paradoxical response, it is an important diagnostic sign for MdDS.
Methods Used in Diagnosis:
- Vestibular tests generally produce normal results. The purpose of performing these tests is to exclude other possible pathologies.
- Imaging techniques such as MRI and CT are also used, but these tests are also usually normal.
How Is Mal de Débarquement Syndrome Treated?
Mal de Débarquement Syndrome is treated using various methods. A method developed by Dr. Mingjia Dai aims to recalibrate the balance system through vestibulo-ocular reflex (VOR) adaptation, head movements, and optokinetic stimulation. This protocol provides significant improvement in symptoms for a large proportion of patients. Treatment is generally administered in short sessions over several days.
As medication therapy:
- Benzodiazepines
- Selective serotonin reuptake inhibitors (SSRIs)
Through their effects on the central nervous system, these medications reduce the sensation of movement and the associated anxiety and depression. Patients generally experience relief with these medications.
Another method still under investigation is repetitive transcranial magnetic stimulation (rTMS). By targeting abnormal neural connections, this method specifically modulates brain activity and offers the potential to relieve symptoms.
Conventional strategies used for symptom management include:
- Reducing visual and sensory stimuli
- Improving sleep
- Managing stress levels
Frequently Asked Questions
Mal de Débarquement Syndrome (MdDS) is a balance disorder characterized by the feeling that a person is still rocking or moving after traveling by ship, airplane, or another vehicle for a prolonged period. Symptoms may last for days or even months.
Although the exact cause of MdDS is unknown, it is thought to be associated with changes in the brain mechanisms that adapt to motion perception. It may be more common particularly in middle-aged women and after long sea journeys.
In MdDS, the person generally experiences rocking, swaying, or the sensation that the ground is moving rather than a spinning sensation. In vertigo, the feeling that the surroundings or the person is spinning is more prominent. This distinction is important for diagnosis.
The diagnosis is made through a detailed patient history and by excluding other balance disorders. Hearing tests, v-HIT, VEMP, VNG, and imaging methods when necessary may be used in the differential diagnosis of other conditions.
Treatment for MdDS is planned according to the severity and duration of symptoms. Vestibular rehabilitation, symptom management, and treatment options recommended by a physician when necessary may improve patients’ quality of life.
Individually planned vestibular rehabilitation programs may help the brain readapt to the balance system. Exercises should be arranged and monitored by an audiologist according to the patient’s symptoms.
In some people, symptoms decrease within a few days or weeks, while in other patients they may continue for a longer period. Recovery time varies from person to person, and early evaluation contributes to creating an appropriate treatment plan.
The constant rocking sensation may make walking, working, driving, and social life difficult. Early diagnosis, appropriate rehabilitation, and regular follow-up may help reduce the impact of symptoms on daily life.
If the rocking sensation is accompanied by sudden hearing loss, speech impairment, altered consciousness, severe headache, double vision, or weakness in the arms or legs, urgent medical evaluation is required.
An audiologist and an ear, nose, and throat specialist should be consulted if a rocking sensation, imbalance, or symptoms affecting quality of life continue for days after travel. Early evaluation is important for accurate diagnosis and appropriate rehabilitation.
Dr. Audiologist Emel Uğur was born in 1982 in Çanakkale. She specialized in Pediatric Audiology, Otologic Disorders, and Vestibular System Disorders, and served for 15 years at the Istanbul Training and Research Hospital. In 2015, she joined the Acıbadem Healthcare Group. She currently works as an Audiologist at the Acıbadem Altunizade Hospital and also serves as a faculty member and program director in the Acıbadem University Vocational School of Health Services Audiometry Program.
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