Mal de debarquement (MDD)
Mal de debarquement or MDD is the persistent feeling of dizziness and imbalance that usually follows after an ocean cruise. It is also called sickness of disembarkment. MDD syndrome can rarely occur after travel in an airplane, train or coach. Exposure of at least 2 hours is necessary to make the diagnosis. MDD should be distinguishes from motion sickness and land sickness.
MDD is much more common in females, especially in the 40-60 year age group. This suggests a hormonal influence. About 1 out of 2000 people may experience MDD in the population. The symptoms may persist for months and even years. Travelling by car often temporarily improve the symptoms.No diagnostic test currently exists that can confirm the diagnosis. Other vestibular pathology should be ruled out first. Vestibular testing is mandatory. Magnetic resonance imaging (MRI) may be ordered to rule out other pathology. There are many theories on the mechanism. Some believe it is a variation of motion sickness. A variant of migraine has been mentioned as a possibility. It is not a psychological condition. When travelling on a ship a person’s brain adapts to the motion on the water not to feel so sick by creating a blue print of the motion in the brain. This blue print is then disposed off when back on solid land. It is believed that a patient suffering from MDD is not able to dispose of this blue print. The patient will then still feel as if on the ship.
Treatment includes medication and specific vestibular therapy. Regular vestibular rehabilitation exercises do not seem to be of any benefit. A new treatment modality where a patient’s head is rolled whilst observing a rotating optokinetic stimulus is currently under investigation.
Patients should be careful of any other treatment suggestions without proper reference.