MoDs

Mal de Débarquement Syndrome (MdDS), also known as Disembarkment Syndrome, is a disorder that affects the balance system of the body. It is characterized by a persistent sense of motion, such as rocking or swaying. People with MdDS also often experience a feeling of instability when standing or walking.

Living with MdDS can be very challenging and frustrating. The constant feeling of movement can be very distressing and disruptive.

Although MdDS is considered a rare condition, it is not uncommon in our practice to encounter patients who have MdDS. Approximately 1 in 100 people who experience dizziness may be affected by MdDS. The condition can affect people of all age groups and genders, but it is most common among women aged 30-60 years.

Symptoms of MdDs

The symptoms of MdDS include a persistent sensation of movement, such as rocking, moving up and down or swaying. This sensation is often relieved when in passive motion, such as when sitting in a moving vehicle. MdDS is usually triggered by movement, but it can also occur spontaneously. Many people experience the onset of symptoms after getting off a moving vehicle, such as a cruise ship, boat, airplane or car. However, a specific trigger is not required to be diagnosed with MdDS. Other common symptoms include nausea, vomiting, headaches, balance problems, difficulty concentrating and mood swings such as anxiety and depression.

MdDS is a complex disorder that has a major impact on the quality of life of those who have it. The duration of symptoms can range from a few days to several years, and in some cases the condition can last a lifetime. Unfortunately, MdDS is often misdiagnosed and common treatment methods have limited effect.

Complex cause

The exact cause of MdDS is not well understood. Several theories have been proposed, including the possibility that it is a disorder related to the brain's ability to adapt to changes in balance. MdDS usually occurs after spending time on a boat and the symptoms occur when returning to solid ground, producing a sensation called "sea legs". When on a boat, the brain is continuously affected by the movement of the waves in different directions, such as rolling, rocking, bobbing, pitching and rocking movements. The brain adapts to this movement through a reflex called the vestibulo-ocular reflex (VOR) to maintain stable vision when the head is in motion. In people with MdDS, there may be an inability to restore the normal balance after being exposed to movement, resulting in the persistent sensation of movement.

MdDS occurs when the balance of the body is disturbed due to problems with the two types of vestibular receptors, the otoliths and the semicircular canals. These receptors send information to the brain about the position of the head in relation to space and gravity.

In the case of MdDS, there is an inability to properly integrate these receptors into the balance system, along with problems in the cerebellum (cerebellum) that normally helps to adapt the reflexes. In order for our eyes to focus on our surroundings when we move our heads, cooperation between the balance and visual systems is essential. When the alignment of the vestibulo-ocular reflex is not working properly in MdDS, the sensation of movement occurs. Restoring proper alignment of this reflex is key to resolving the condition.

Research shows that it is possible to teach the body to readapt, which can alleviate the symptoms of MdDS. A 2014 study entitled "Readaptation of the vestibulo-ocular reflex relieves the Mal de Débarquement syndrome" proposed a treatment method that focused on correcting the maladaptation of the vestibulo-ocular reflex in MdDS. The treatment involved the use of a special visual stimulation called optokinetic stimuli (OKN) along with movements of the head in the direction the patient perceived they were moving. The aim was to help the body re-adapt the reflex correctly and reduce the perception of their own movement. Of the 24 participants in the study, 17 (70%) became symptom-free after the treatment and remained so for up to four months afterwards. We use this particular treatment in the clinic, along with other therapies.

Our approach

Our process starts with a thorough medical history, which can reveal any relevant issues or other health problems that may be hampering your progress.

Through our examination, we identify the specific areas and pathways in your brain that are affected. We use advanced technologies to measure the function of your visual, vestibular and proprioceptive systems, as well as your balance under different sensory conditions. We also use neurosensory-motor integration testing for hand-eye coordination and cognition.

In addition to these tests, we perform a comprehensive physical and neurological examination of your sensory, motor, autonomic and cognitive systems. We review relevant laboratory tests, radiological images and previous neurodiagnostic results to integrate all available information.

This comprehensive evaluation allows us to determine which parts of your brain are functioning correctly, which systems are struggling and at what point your systems become fatigued. With this knowledge, we design a personalized treatment plan exclusively for your brain and its needs.

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