Unraveling Rare: Mal De Debarqument Syndrome

Mal de Debarqument Syndrome (MdDS) literally means “sickness of disembarkment.” It is a rare and not well understood disorder impacting the vestibular system. A person with this disorder feels unbalanced, or has a rocking sensation, after disembarking from an ocean cruise, airplane trip or other motion experience. The majority of people will feel a sensation of motion after such an experience but this lasts only a short period, with two days being the upper limit of normal. However, for those suffering with MdDS, this sensation can persist for a month or up to a year. Uncommonly, MdDS can continue for several years. The disease course is different from person to person and may lessen with time yet can return at different intervals. Sometimes, it may just resolve spontaneously.

The epidemiolgy in the US is still not known. Usually, it is most common in middle aged women and happens in those who were previously healthy. There are no studies delineating the difference across races or other demographic factors. It can result in trips as short as 30 minutes.

What are the signs and symptoms of MdDS?

• Feeling of rocking/swaying/disequilibrium
• May be accompanied by anxiety or depression
• Nausea
• Seldom is true vertigo observed
• Symptoms are usually worse when patient is an enclosed space or trying to be motionless, such as lying down in bed
• Stress and/or fatigue can make the symptoms worse
• It negatively impacts the patient’s quality of life

MdDS occurs when an exposure to a movement sensation occurs and then is removed. No one knows the exact underlying etiology for certain. However, the leading theory is that it most likely starts in the balance centers in the brain and not the inner ear. It has been theorized that the brain sends out signals to regulate the stimuli of the new motion to the legs and other body parts to preserve the sensation of balance, or as it is called, finding one’s “sea legs.”

This maintenance of balance continues after disembarkment. In some, the brain does not immediately return to the old pattern of orientation. Another theory is that MdDS is a migraine variant.

At the present time, there are no diagnostic tests to detect MdDS. Rather, the diagnosis is determined by history and exclusion of other diseases. No structural abnormalities are detected on brain MRI. Inner ear function tests are also normal.

Furthermore, there are no known cures for this disorder. Medications such as Meclizine and scopolamine used in the treatment of motion sickness usually offer no benefit in patients with MdDS. Some treatments that have shown some potential effect include benzodiazepans, vestibular rehabilitation, and tricyclic antidepressants. While there is no prevention other than avoiding similar trips in the future, some have seen the use of benzodiazepans before travel provide some relief. Some positive results have been observed with neuromodulation and modulation of the vestibule-ocular reflex.

Most research studies currently being conducted in MdDS are focusing on developing an understanding of this disease.

About the Author

Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions.  Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University where she was recognized as intern of the year.  She is a blogger for Physician’s Weekly and MedicalPractice Insider as well as a guest columnist for Medcity New, PM360 and HIT Outcomes. She has had articles published in several other media outlets. She has authored the books, “Inside Our Broken Healthcare System”, “The War on Doctors” and “The Healthcare Apocalypse.” She has been interviewed in US News and on NBC Nightly News.