Mal de Debarquement Syndrome – Navigating Life with the ‘Sea Legs’ Sensation

Mal de Debarquement Syndrome (MdDS) is a rare vestibular disorder that disrupts the body’s sense of balance, often being described as a sensation of being in motion even when you are stationary. Also known as “land sickness,” MdDS typically happens after exposure to passive motion experiences like being on a boat, plane, or in environments with continual movement, such as water beds or exercise machines.^(1,2)

People who are affected by Mal de Debarquement Syndrome tend to experience persistent sensations of self-motion and rocking or swaying, resembling the feeling of being on a boat even when they are on solid ground. These symptoms can last for extended periods, sometimes lasting for months or even years after the triggering event. Despite being motionless, those with Mal de Debarquement Syndrome often feel as though they are continuously walking on an unsteady surface or experiencing a gentle rocking sensation.⁽³⁾

Moreover, there is also a variant of Mal de Debarquement Syndrome known as “mixed” or “spontaneous” MdDS, which is different in that it lacks a specific triggering event. Researchers speculate that this form of Mal de Debarquement Syndrome could be linked to migraine disease, presenting with similar symptoms, but emerging without an identifiable initial cause. Understanding the various forms and triggers of Mal de Debarquement Syndrome is crucial for accurate diagnosis and management of this perplexing vestibular syndrome.^(4,5,6)

Mal de Debarquement Syndrome (MdDS) primarily manifests as a persistent sensation of motion, specifically a sensation of rocking or swaying, rather than spinning dizziness. This feeling of motion persists even when the individual is stationary, setting it apart from other vestibular disorders. It is important to emphasize that Mal de Debarquement Syndrome or MdDS symptoms occur independently of any head movements, which is what distinguishes it from other similar conditions.⁽⁷⁾

In addition to the primary symptom of continuous motion sensation, individuals with Mal de Debarquement Syndrome may also experience the following symptoms:

• Feelings of imbalance: Patients often describe a sense of unsteadiness or imbalance, contributing to a persistent feeling of insecurity while walking or standing.
• Increased Fatigue: MdDS can be accompanied by heightened fatigue levels, potentially impacting daily activities and energy levels.
• Cognitive symptoms: Some people with this syndrome report experiencing brain fog, confusion, or cognitive difficulties, affecting their mental clarity and focus.
• Mood changes: MdDS may lead to alterations in mood, including heightened anxiety or feelings of irritability, which can further impact the overall well-being of the affected person.

Symptoms tend to be more pronounced when individuals are at rest, such as when sitting or lying down, and can also intensify in environments where there is rapid visual stimuli, such as crowded or visually stimulating places like supermarkets. Paradoxically, passive motion, such as being in a moving vehicle, might actually temporarily alleviate the symptoms. Additionally, exposure to flashing lights or swift movements can very well trigger or aggravate the symptoms of MdDS.⁽⁸⁾ 

Diagnosing Mal de Debarquement Syndrome (MdDS) poses significant challenges for doctors because of the absence of specific clinical markers. Typically, the diagnosis of Mal de Debarquement Syndrome involves a comprehensive evaluation, which primarily looks at excluding other potential vestibular disorders and medical conditions that might present with similar symptoms.

Healthcare providers often initiate the diagnostic process by conducting various tests and examinations, including:

• Clinical assessments: Doctors are likely to ask for a thorough medical history review and conduct thorough physical examination to identify specific symptoms associated with MdDS, such as a persistent sensation of motion or unsteadiness.
• Vestibular testing: Evaluations like the Romberg test, which assesses an individual’s balance and proprioception while standing with eyes closed, may be performed to observe any signs of vestibular dysfunction. ^(9,10)
• Laboratory tests: Blood tests may be conducted to rule out other medical conditions that could potentially cause similar symptoms and to ensure there are no underlying metabolic or hormonal imbalances contributing to the sensations experienced in Mal de Debarquement Syndrome or MdDS.
• Imaging tests: While imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans do not directly diagnose MdDS, they might be recommended to rule out structural abnormalities or other pathologies in the brain or inner ear that could cause vestibular symptoms.

During the diagnostic process, healthcare professionals focus on systematically excluding other possible vestibular disorders and medical conditions. This is because the absence of definitive diagnostic markers for MdDS necessitates that a diagnosis is reached through the process of elimination.

Managing Mal de Debarquement Syndrome (MdDS) poses a challenge as there is no universal treatment that exists to guarantee complete remission of symptoms for all individuals affected. While some individuals might experience natural recovery over time, others may require a combination of therapeutic approaches to relieve and manage their symptoms effectively.

Various treatment modalities can be prescribed to address the symptoms of Mal de Debarquement Syndrome, including:

1. Vestibular Rehabilitation: Vestibular rehabilitation therapy (VRT) is a specialized form of physical therapy focused on enhancing vestibular function and improving balance. Customized exercises designed to retrain the brain’s response to vestibular signals may help alleviate symptoms of imbalance and dizziness.⁽¹¹⁾
2. Medications: Certain medications, such as benzodiazepines or selective serotonin reuptake inhibitors (SSRIs), might be prescribed to manage specific symptoms associated with Mal de Debarquement Syndrome, such as anxiety or mood disturbances. However, their efficacy in alleviating core MdDS symptoms varies among individuals.
3. Optokinetic Rehabilitation: The optokinetic rehabilitation protocol, pioneered by Dr. Mingjia Dai at Mount Sinai Hospital, New York City, has shown promise in reducing MdDS symptoms. This specialized treatment involves combining controlled physical movements with visual stimuli to re-establish normal sensory input to the brain. It has demonstrated effectiveness in reducing symptoms in a significant percentage of individuals, although access to this treatment remains limited, available at select clinics globally.⁽¹²⁾
4. Brain Stimulation Techniques: Certain forms of non-invasive brain stimulation, such as transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS), are being explored as potential therapeutic options for managing MdDS symptoms. However, their efficacy and long-term benefits require further research and evaluation.

Given the differences in symptom severity and individual response to treatments, a tailored and multidisciplinary approach involving physical therapists, neurologists, and other specialists might be necessary to determine the most effective treatment strategies for each person with MdDS.

Mal de Debarquement Syndrome (MdDS) predominantly affects a person’s sensory perception, causing persistent sensations of motion and imbalance. Physically, MdDS itself does not lead to any direct complications or physical impairments. However, the prolonged experience of ongoing disorientation and imbalance can significantly impact a person’s mental well-being. Individuals experiencing prolonged Mal de Debarquement Syndrome symptoms might develop anxiety, depression, or other mood-related disorders due to the distressing and persistent nature of the condition.

Mal de Debarquement Syndrome or MdDS tends to affect more women than men, with up to 85 percent of reported cases occurring in women. Furthermore, age appears to be a contributing factor, with the onset of MdDS symptoms often observed in middle-aged individuals, particularly around the perimenopausal phase. Individuals with a history of migraines might also have an increased risk of developing Mal de Debarquement Syndrome.⁽¹³⁾

The higher prevalence in women and the association with specific age groups seems to suggest a potential hormonal or physiological link in the onset or exacerbation of Mal de Debarquement Syndrome symptoms. However, further research is required to gain a comprehensive understanding of the exact relationship between hormonal changes, age, and the development of Mal de Debarquement Syndrome symptoms in susceptible individuals.

The prognosis for Mal de Debarquement Syndrome (MdDS) varies among individuals. While some individuals may observe an improvement in their symptoms over time, others may endure persistent symptoms necessitating a range of treatments for an extended duration, spanning from months to years. As the prognosis differs for each person affected by MdDS, ongoing research and a deeper understanding of this condition are crucial to developing more effective interventions and improving the quality of life for those impacted by this rare vestibular disorder.

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