Mal de débarquement syndrome diagnostic criteria: Consensus document of the Classification Committee of the Bárány Society

Abstract

We present diagnostic criteria for mal de débarquement syndrome (MdDS) for inclusion into the International Classification of Vestibular Disorders. The criteria include the following: 1] Non-spinning vertigo characterized by an oscillatory sensation (‘rocking,’ ‘bobbing,’ or ‘swaying,’) present continuously or for most of the day; 2] Onset occurs within 48 hours after the end of exposure to passive motion, 3] Symptoms temporarily reduce with exposure to passive motion (e.g. driving), and 4] Symptoms persist for >48 hours. MdDS may be designated as “in evolution,” if symptoms are ongoing but the observation period has been less than 1 month; “transient,” if symptoms resolve at or before 1 month and the observation period extends at least to the resolution point; or “persistent” if symptoms last for more than 1 month. Individuals with MdDS may develop co-existing symptoms of spatial disorientation, visual motion intolerance, fatigue, and exacerbation of headaches or anxiety. Features that distinguish MdDS from vestibular migraine, motion sickness, and persistent postural perceptual dizziness (PPPD) are reviewed. Motion-moderated oscillatory vertigo can also occur without a motion trigger, typically following another vestibular disorder, a medical illness, heightened psychological stress, or metabolic disturbance. Terminology for this non-motion triggered presentation has been varied as it has features of both MdDS and PPPD. Further research is needed into its phenomenological and biological relationship to MdDS, PPPD, and other vestibular disorders.

Remotely Monitored Home-Based Neuromodulation With Transcranial Alternating Current Stimulation (tACS) for Mal de Débarquement Syndrome

“…Participants in an on-site tACS study that involved travel to the study site were given the opportunity to take part in an at-home extension phase of the study. The original group of participants were selected based on meeting inclusion criteria for MdDS, which were consistent with Bárány Society criteria ( 1 ) except that their symptoms had to have lasted at least 6-months and they had failed medically available treatments including a trial of a selective serotonin reuptake inhibitor, a benzodiazepine, and physical therapy ( 19 ). This was to ensure a favorable risk-to-benefit ratio for trying experimental therapy and to reduce risks of placebo effects.…”

“…Mal de Débarquement Syndrome (MdDS) is a neurotological disorder that occurs after exposure to oscillating motion such as from water, air, or land travel ( 1 , 2 ). The motion perception of MdDS, typically described as a “rocking,” “bobbing,” or “swaying,” is temporarily suppressed by re-exposure to passive motion, but worsens after the motion stops ( 3 ).…”

“…The challenging feature of MdDS is that it is induced by travel and is worsened by travel ( 1 , 13 ). Worsening by travel remains a formidable challenge to treating MdDS accounting at least in part for its intractableness since transportation is a necessary part of modern life.…”

Neuroimaging Markers of Mal de Débarquement Syndrome

“…Mal de débarquement syndrome (MdDS) is a disorder of persistent oscillating vertigo that follows entrainment to passive motion such as during water, air, or land travel (1). Symptoms are described as a "rocking, " "bobbing, " or "swaying" perception that is nulled by exposure to passive motion such as driving/riding in a car or returning to the triggering stimulus.…”

Seltenere, aber klinisch relevante episodische Schwindelsyndrome

“…Die Symptome können sich vorübergehend während erneuter passiver Körperbewegungen (z. B. Autofahrten) verringern[23].Als persistierend wird ein MdDS bezeichnet, wenn es länger als einen Monat anhält. Es ist dann in der Regel behandlungsbedürftig, aber häufig schwer therapierbar[24,25], außerdem ist dann eine klare Abgrenzung zum funktionellen Schwindel wie dem phobischen Schwankschwindel nicht einfach.…”