"Medical Mystery: Disembarkment Syndrome" or mal de debarquement syndrome

Just when I think I got a handle on it...it comes back to bite me.....This is information in found online at www.vestibular.org/vestibular-disorders/specific-disorders/mal-de-debarquement.php


Mal de Debarquement

Mal de debarquement literally means "sickness of disembarkment." This term originally referred to the illusion of movement felt as an aftereffect of travel by ship or boat. Some experts now include other types of travel (such as by train and airplane) and situations with new and different movement patterns (such as reclining on a waterbed).

For a handful of people, this illusion of movement seems to last for long periods of time: weeks to months, even years after a voyage. Some physicians refer to it as mal de debarquement syndrome, reflecting that it is a collection of symptoms rather than a specific disease. There is no universal agreement among physicians about what mal de debarquement is or how to diagnose it. Not all doctors even agree that persistent mal de debarquement exists.

Leading explanations for the syndrome conclude that the problem is not in the inner ear and most likely occurs someplace in the balance areas of the brain. The brain adapts to the motion of the ship or other vehicle; but once the movement stops, the brain is unable to readapt once again. Why this ability to adapt would suddenly stop is not understood. One theory is that mal de debarquement is a migraine variant; long-lasting mal de debarquement is experienced by middle-aged woman more than by other groups, and more women than men experience migraines.

Symptoms of mal de debarquement include the sensation of bobbing, rocking, swaying, swinging, floating and/or tumbling. These may be accompanied by unsteadiness, disequilibrium, anxiety, difficulty concentrating, and a loss of self-confidence. The symptoms usually increase in enclosed spaces and when trying to be motionless such as when attempting to fall asleep in bed or when stopped at a traffic light. The symptoms improve during constant, steady movement such as experienced while in a moving car. Mal de debarquement does not include spinning vertigo, vomiting, cold sweat, ear pressure, ear pain, sound sensitivity, tinnitus, hearing loss or distortion, double vision, or bouncing vision.

Persistent mal de debarquement usually begins within hours of stopping the novel movement and resolves within about six to twelve months. There are also reports of it not resolving for years.

A physician diagnoses mal de debarquement by collecting a thorough history, conducting a physical examination, and doing tests to rule out other causes for the symptoms. For a diagnosis of mal de debarquement to be made, there must be a history of a ship voyage or other new movement, the return to a normal environment, and then the start of the symptoms. Symptoms start immediately, not weeks or months later.

At this time there appears to be no single highly successful treatment approach to mal de debarquement. Standard drugs given for motion sickness (including meclizine, diphenhydrinate, and scopolamine patches) seem to be ineffective. Some treatments suggested by physicians include walking while watching the horizon, vestibular rehabilitation therapy, diuretics, anti-seizure drugs, antidepressants of the tricyclic family, and benzodiazepines.

From VEDA publication F-29, Mal de Debarquement, available in VEDA's online store.