Mal de Debarquement (MDD)
Timothy C. Hain, MD,
Last updated 11/02
What is Mal de Debarquement?
Mal de Debarquement (MDD) is a type of vertigo and imbalance that occurs after getting off of a boat, or sometimes, after a long airplane ride. Most individuals with this diagnosis are women between the ages of 40 and 50 who go on a seven-day cruise. After getting off the boat, or "debarking" (debarquement), they develop a rocking sensation, as if they are still on the boat. The rocking sensation may persist for months or even years! Most people seem to have it for a month or less. Nevertheless, a recent study of MDD (Hain et al, 1999) showed that it can last much longer (see Figure 1).
What Causes Mal de Debarquement?
Little is known about this rare disorder. It is clear, however, that MDD is not cause by an injury to the ear or brain. Some dizziness experts believe that MDD is caused by a variant of migraine. Because the condition largely occurs in females, it may also have something to do with sex hormones, such as estrogen or progesterone. It could also be genetic, related to two copies of the X chromosome perhaps combined with other susceptibility factors. It seems unlikely to be a psychological disturbance; although it is always difficult to entirely exclude psychological problems, the male -to-female ratio and other aspects of this disorder would make this unlikely.
How is Mal de Debarquement Diagnosed?
The diagnosis is made by a combination of the history (rocking after prolonged exposure to a boat), and exclusion of reasonable alternatives. Tests to exclude Meniere's disease should be done, and if there is a history of plane flight, perilymph fistula should also be considered. A typical person is a woman of appropriate age (see Figure 2), who has gone on a cruise and who is now rocking.
The following diagnostic tests are generally performed:
How is Mal de Debarquement Treated?
Medical Treatment
After the MDD has started, most medications that work for other forms of dizziness or motion sickness are ineffective. Specifically, Antivert, Bonine, meclizine, Dramamine, scopolamine seem to be of little use. Valium and related medications such as Klonapin are helpful in some persons. There is some worry that these medications may prolong the duration of symptoms (although this worry has not yet been tested by a research study). An antidepressant called amitryptyline may also be helpful. Hormonal medications such as estrogen or progesterone might be problematic -- it might be worth a trial of stopping them if this is practical. Anecdotally, non-steroidal anti-inflammatory medications such as Celebrex or Voixx can help. Also anecdotally, phenytoin, carbamazepine and related drugs may be useful in reducing symptoms. A controlled trial of these medications may be in order, if more evidence accumulates.
Prevention
It is possible that medications taken prior and during boat travel might prevent development of MDD. Again, this possibility has not been tested by a research study. Nevertheless, medications that suppress the inner ear or block adaptation to inner ear signals might be useful. Anecdotal evidence suggests that while meclizine and scopolamine are ineffective, some people can prevent MDD by taking diazepam or lorazepam prior to getting on the boat or airplane. Avoidance of motion is clearly helpful. If you get dizzy from riding on boats, don't do it!
Physical Therapy
Physical therapy may be helpful in MDD but the evidence really isn't there. In one study (Hain et al, 1999), 10 out of 15 persons who had vestibular rehabilitation reported improvement. However, as there were no controls in this study, the improvement might have occured in any case, and it is the trend for MDD to gradually improve over months. Zimbelman (see References) has written a review of rehabilitation in MDD.
How Might Mal de Debarquement Affect My Life?
Persons with MDD often have impaired balance. They often choose to travel less to avoid motion exposures. MDD is not life-threatening.
Research Studies in Mal de Debarquement
Little research has been done on MDD, and what has been done largely relates to attempts to quantify how often the condition occurs. We know of no formal reserach regarding treatment of MDD. At the American Hearing Research Foundation (AHRF), we have funded basic research on dizziness and balance disorders in the past, and are interested in funding research on MDD in the future. Click here if you would you would like more information about contributing to the AHRF's efforts to manage Mal de Debarquement.
References
- Brown JJ, Baloh RW. Persistent Mal de Debarquement Syndrome: a motion-induced subjective disorder of balance. Am J Otolaryngol 219-222, 1987
- Gorden CR, Spitzer O, Shupak A, Doweck I. Survey of mal de debarquement. British Medical J 1992:304, 544
- Gorden CR, Spitzer O, Doweck, Melemed Y, Shupak A. Clinical features of Mal De Debarquement: adaptation and habituation to sea conditions. JVR 5,5, 363-369, 1995
- Hain TC, Hanna PA, Rheinberger MA. Mal de Debarquement. Arch Otolaryngol Head Neck Surg 1999;125:615-620
- Murphy TP. Mal de Debarquement syndrome: a forgotten entity ? Otol HNS 1993:109:10-13
- Mair IWS. The mal de debarquement syndrome. J. Audiological Med 5, 21-25, 1996
- Zimbelman JL, Walton TM. Vestibular rehabilitation of a patient with persistent Mal de Debarquement. Physical Therapy Case Reports, 1999;2(4):129-137
- Web pages: MDD page
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