Definition and Overview
Mal de Debarquement Syndrome (MdDS) is a vestibular disorder in which the feeling of shaking or shaking of the body persists after experiencing passive movement such as a boat or airplane. Similar sensations that appear briefly right after the end of the movement are common even in healthy people, but if the symptoms persist for more than a month, they are classified as post-disembarkation syndrome.
The ICD-10 code applies R42 (dizziness and vertigo).
It mostly occurs after ship travel (cruises), but has also been reported after travel by plane, train, or car. Patients complain of shaking, a feeling of hesitation, and a feeling of floating, and are often not accompanied by rotational dizziness or changes in hearing.
Features
The most characteristic finding of post-disembarkation syndrome is that symptoms are paradoxically alleviated when the patient is exposed to movement again through driving or riding. The shaking decreases while driving or riding in a vehicle and receiving passive or active movements, but when you get out of the car and stop, the symptoms reappear.
This aspect is distinguished from dizziness worsened by movement, such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis, and is used as a key clue in diagnosis.
Epidemiology
It is more commonly reported in women, and the majority of reported patients are middle-aged women. Although the exact prevalence rate has not been established, systematic literature reviews have indicated that delayed diagnosis and misdiagnosis are common.
There are reports that the frequency of comorbidity is high in patients with a history of migraine, and it is suggested that stress and hormonal changes are involved in symptom fluctuations.
diagnosis
Post-disembarkation syndrome is diagnosed according to the consensus diagnostic criteria proposed by the classification committee of the Bárány Society.
Key requirements for diagnosis:
- Non-rotational shaking, shaking, and floating sensation that begins immediately after passive movement (ship, aircraft, etc.)
- Symptoms are relieved upon re-exposure, such as driving or riding, but recur when stopped.
- Symptoms last more than 48 hours (typically more than a month)
- Not explained by other vestibular or nervous system diseases
Brain magnetic resonance imaging (MRI) and vestibular function tests are mostly normal and are performed to rule out other causes such as stroke, vestibular neuritis, Meniere's disease, and vestibular migraine.
treatment
vestibular rehabilitation
Vestibular rehabilitation induces symptom adaptation through balance training and habituation exercises. In some patients, the intensity of shaking and the degree of disruption to daily life are reduced.
Photopic motor stimulation
Optokinetic stimulation is a treatment that realigns the vestibulo-ocular reflex by combining head movements with rotating visual stimulation. In the study, some patients reported significant improvement in symptoms.
medication
Benzodiazepine drugs (such as clonazepam) and some antidepressants are used to relieve symptoms. The evidence for drug treatment is limited, and responses vary depending on the patient.
Symptoms may become chronic in some cases, but some patients improve naturally over time.