Mal de debarquement …

Douglas J Lanska MD MS MSPH

General Neurology

Updated 05.14.2024
Released 09.25.2001
Expires For CME 05.14.2027

Mal de debarquement

Author: Douglas J Lanska MD MS MSPH

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Mal de debarquement

In This Article

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Introduction

Overview

This article discusses the clinical presentation, pathophysiology, diagnostic workup, and management of mal de debarquement syndrome. Mal de debarquement is an inappropriate sensation of movement after termination of motion that is accompanied by disequilibrium but not vertigo. Mal de debarquement is usually experienced after a sea voyage, and middle-aged women seem particularly susceptible to persistent symptoms of mal de debarquement. In a study, Dai and colleagues provided evidence that readaptation of the vestibulo-ocular reflex can produce a high rate of cure or substantial relief in patients with persistent mal de debarquement syndrome.

Key points

	• Mal de debarquement is an inappropriate sensation of movement after termination of motion that is accompanied by disequilibrium, but not vertigo, usually experienced after a sea voyage. The term “persistent mal de debarquement” is reserved for cases lasting 1 month or more.
	• Symptoms of mal de debarquement include sensations of rocking, swaying, swinging, unsteadiness, and disequilibrium.
	• Neurologic examination is generally normal in both mal de debarquement and persistent mal de debarquement. History and physical examination are usually sufficient, and no diagnostic tests are required.
	• Mal de debarquement is distinct from motion sickness because subjects experience symptoms following termination of motion rather than during the period of motion.
	• Although most cases resolve spontaneously, middle-aged women seem particularly likely to experience protracted symptoms following an ocean cruise, with persistence of symptoms for many years.
	• On the premise that maladapted rocking sensations and the associated physical symptoms could be diminished or eliminated by readapting the vestibulo-ocular reflex, rolling the head from side to side while watching a rotating full-field stimulus produced either a cure or a substantial improvement in 70% of subjects with persistent mal de debarquement syndrome for a period of approximately 1 year on average.

Historical note and terminology

	• Mal de debarquement is an inappropriate sensation of movement after termination of motion that is accompanied by disequilibrium but not vertigo.
	• Symptoms of mal de debarquement include sensations of rocking, swaying, swinging, unsteadiness, and disequilibrium.
	• Mal de debarquement is usually experienced after a sea voyage but can also occur following other means of conveyance, such as car, train, air, or space travel.
	• Mal de debarquement is distinct from motion sickness because subjects experience symptoms following termination of motion rather than during the period of motion, and subjects with mal de debarquement do not commonly have associated nausea, vomiting, diaphoresis, or headache.
	• Mal de debarquement and land sickness are considered to be synonymous and to encompass both transient and persistent symptoms following sea, air, or land travel; the term "persistent mal de debarquement" is reserved for cases lasting 1 month or more.

In 1796, English physician Erasmus Darwin (1731-1802), the grandfather of naturalist Charles Darwin (1809-1882), gave an early description of mal de debarquement syndrome:

English physician Erasmus Darwin (1792)

Painting by Joseph Wright of Derby (1734–1797). (Courtesy of Wikipedia. Contributed by Dr. Douglas J Lanska.)

Those, who have been upon the water in a boat or ship so long, that they have acquired the necessary habits of motion upon that unstable element, at their return on land frequently think in their reveries, or between sleeping and waking, that they observe the room, they sit in, or some of its furniture, to librate like the motion of the vessel. This I have experienced myself, and have been told, that after long voyages, it is some time before these ideas entirely vanish. The same is observable in a less degree after having travelled some days in a stage coach, and particularly when we lie down in bed, and compose ourselves to sleep; in this case it is observable, that the rattling noise of the coach, as well as the undulatory motion, haunts us (28).

In 1881, Irish-American physician John Arthur Irwin (1853-1912) noted that sailors gradually adapt to the motion of a ship and that this adaptation may prove problematic on returning to land:

Irish-American physician John Arthur Irwin (1853-1912)

Source: Anonymous. Irwin, John Arthur. In: The national cyclopaedia of American biography: being the history of the United States as illustrated in the lives of the founders, builders, and defenders of the Republic, and of the ...

Upon the ocean habit teaches the [semicircular] canals to adapt themselves to the new condition of things, and to pass over unheeded erroneous impressions which were noticed at first. In fact, the new habit may become so strong that a disturbance of it, by a return to land, will be marked by a similar phenomenon; hence the unsteady gait sometimes observable in a not-drunken sailor during his first few hours on shore after a long and stormy voyage (39; 02).

English crime novelist Agatha Christie (1890-1976) also described this phenomenon in her novel Sleeping Murder:

Gwenda Reed stood, shivered a little, on the quayside. The docks and the custom sheds and all of England that she could see were gently waving up and down…She had only just got off that heaving, creaking boat (it had been an exceptionally rough three days through the Bay and up to Plymouth)…On the following morning…the universe in general was no longer waving and wobbling. It had steadied down… (20).

Mal de debarquement is an inappropriate sensation of movement after termination of motion accompanied by disequilibrium but not vertigo. Mal de debarquement is usually experienced after a sea voyage (39; 10; 33; 32; 55; 22; 23; 46; 36; 62; 08; 61; 63; 64), but can also occur following other means of conveyance, such as car travel, train travel, air travel, or space travel (37; 48; 07; 10; 60; 55; 36). Mal de debarquement is distinct from motion sickness because subjects experience symptoms following termination of motion rather than during the period of motion, and subjects with mal de debarquement do not commonly have associated nausea, vomiting, diaphoresis, or headache (46; 36).

Some authors consider mal de debarquement to encompass cases with transient (less than 48 hours) symptoms (33; 32). Others refer to transient symptom cases as "land sickness" and reserve the term "mal de debarquement" for cases with symptoms with a duration of at least 1 month (10; 36). Others have proposed that “mal de debarquement” be used for transient symptoms and “mal de debarquement syndrome” be used for persistent symptoms lasting 1 month or more (63), but the use of the term “syndrome” to distinguish only a long duration of symptoms is really a misuse of the term and is less descriptive than simply saying persistent mal de debarquement. In this review, mal de debarquement and land sickness are considered to be synonymous and to encompass both transient and persistent symptoms following sea, air, or land travel; the term "persistent mal de debarquement" is reserved for cases lasting 1 month or more.

Clinical manifestations

Presentation and course

	• Mal de debarquement is an inappropriate sensation of movement after termination of motion that is accompanied by disequilibrium but not vertigo.
	• Symptoms of mal de debarquement include sensations of rocking, swaying, swinging, unsteadiness, and disequilibrium.
	• Mal de debarquement is usually experienced after a sea voyage; most cases begin immediately on returning to land, but up to 25% may develop within 6 hours of disembarkation, and occasionally some develop later than this.
	• Mal de debarquement can also occur following other means of conveyance, such as car, train, air, or space travel.
	• Duration is usually less than 24 hours, but some may gradually resolve over a few days.
	• Persistent mal de debarquement is more common in middle-aged women.
	• Self-reported mal de debarquement syndrome is associated with high levels of depression and illness intrusiveness.
	• Neurologic examination is generally normal in both mal de debarquement and persistent mal de debarquement.

Symptoms of mal de debarquement include sensations of rocking, swaying, swinging, unsteadiness, and disequilibrium. For example, Groen reported, "the former passenger feels himself rising and rolling when in the hotel bed on shore" (34).

In general, no associated audiologic, vestibular, or vegetative symptoms are present (ie, tinnitus, hearing loss, hyperacusis, aural fullness, vertigo, nausea, vomiting, or headache). In reports where additional symptoms are described, patients were recruited from populations of "dizzy" patients (36; 18), and it is difficult to be sure that these subjects did not have other coincident audiovestibular or headache disorders (31). However, it is not surprising that the sensation of chronic rocking dizziness associated with mal de debarquement syndrome may cause or aggravate headaches in susceptible individuals (18; 01). In addition, patients with vestibular migraine may be more susceptible to developing mal de debarquement (65), and they may be more disabled than individuals with mal de debarquement who do not have vestibular migraine, in terms of severity of dizziness, job impact, and number of symptoms (06).

Some cases develop mal de debarquement after relatively short voyages of several hours (55; 22; 50). Most cases begin immediately on returning to land, but up to 25% may develop within 6 hours of disembarkation (33; 32; 22); occasional cases reportedly may not begin for several days after disembarkation (32). Mal de debarquement can also occur following other means of conveyance, such as car, train, air, or space travel. Duration is usually less than 24 hours (33; 32), but some may gradually resolve over a few days (34; 32; 22). A few patients have difficulty driving until the symptoms subside (32).

Mal de debarquement has been mostly reported in adults, particularly women, but children may also develop mal de debarquement (57). Diagnostic delays are frequent due to underrecognition of mal de debarquement among children (57).

A small minority of patients may develop persistent symptoms, sometimes lasting more than 5 years (16; 13; 14). Persistent mal de debarquement appears more common in middle-aged women (10; 46; 36; 35; 08; 16; 13). Some patients with persistent symptoms develop spontaneous episodes of mal de debarquement-like symptoms after the initial mal de debarquement episode (16). Migraine is more common for those who develop spontaneous recurrences. In one study, nearly all patients suffering from mal de debarquement had a personal or family history of migraine headaches or signs or symptoms suggestive of atypical migraine (30).

Self-reported mal de debarquement syndrome is associated with high levels of depression, anxiety-related disorders, history of substance use disorders, and illness intrusiveness (04; 59). Mal de debarquement-related disability is associated with the severity of depression, anxiety, and neuroticism but not with the severity of mal de debarquement (59).

Neurologic examination is generally normal in both mal de debarquement and persistent mal de debarquement (46; 62; 16; 13; 63; 64), except possibly for some hesitancy in performing tests of balance (10) or some mild unsteadiness with ambulation. However, reported physical findings in some patients have included body oscillation at 0.2 Hz, oscillating vertical nystagmus when the head is rolled from side to side in darkness and unilateral rotation during the Fukuda stepping test (25). Symptoms may improve with the return to a ship (10; 32) or with reexposure to other passive motion (16).

Prognosis and complications

Most cases resolve spontaneously. However, middle-aged women seem to be particularly likely to experience protracted symptoms following an ocean cruise, with persistence of symptoms for many years (10; 55; 46; 36; 35; 62; 16; 13). Most mal de debarquement episodes lasting longer than 3 days resolve within a year, but the probability of resolution declines each year (19). Mal de debarquement dramatically impacts quality of life and imposes a considerable economic burden on affected patients (45).

Clinical vignette

Case 1. A 29-year-old man noted 2 days of mild but persistent dizziness and disequilibrium, which began immediately following disembarkation from a 2-week sailing trip. One night, in the middle of the trip, he experienced moderate sea sickness (without vomiting) when in the ship cabin at a mooring during a nocturnal tropical storm. Symptoms following disembarkation included mild disequilibrium when standing and walking and a rocking or swaying sensation when standing, sitting, or supine. Past history was unremarkable, and there was no associated vertigo, oscillopsia, hearing loss, hyperacusis, tinnitus, aural fullness, otalgia, nausea, vomiting, headache, or paresthesias. Symptoms gradually resolved without treatment.

Case 2. A 61-year-old woman noted 5 months of persistent imbalance and rocking sensations following a 7-day houseboat cruise. Other passengers had similar symptoms that resolved within a few days, whereas her symptoms persisted. Her symptoms were exacerbated by riding in an elevator as well as by heights. Examination was not reported (10).

Biological basis

• The etiology of mal de debarquement is unknown.

Etiology and pathogenesis

The etiology of mal de debarquement is unknown (63; 64). It may result from an aberrant adaptive response to passive motion (42), defective or delayed readaptation or recalibration of vestibular pathways following cessation of motion (32; 46), or “pseudo-hallucinations” from vestibular memory, ie, stored vestibular information from the hippocampus (50). Individuals susceptible to mal de debarquement have a relatively greater dependence on the somatosensory system than the vestibular or visual systems for maintenance of balance (56).

Sea (or space) travel presents the vestibular, visual, and proprioceptive systems with a series of unnatural and unpredictable movements of varying amplitude in a variety of planes (pitch, yaw, and roll), producing various sensory conflicts (58; 60; 05). In contrast, terrestrial travel generally is associated with much more regular and predictable movements without simultaneous shifts in different planes. The normal short-term multisensory adaptive response to sea travel and ship motion is recognized in the expression "getting one's sea legs." Postural sway excursion and variability increase in individuals with minimal offshore experience after disembarking (05). Sensory reorganization difficulties maintaining an upright posture in challenging sensory conditions depends on vestibular and somatosensory inputs (05), the cerebellar flocculus, and the vestibular nuclei (60). Once this multisensory adaptive process, what some have called developing a new “internal model,” has occurred, post-voyage movements on land are awkward until a similar compensatory readaptation or recalibration to the conditions on land occurs. This period of readaptation is what is experienced as mal de debarquement. For unknown reasons, some patients apparently have difficulty with this readaptation process and experience persistent mal de debarquement.

The caudal aspect of the parabrachial nucleus contains neurons that are responsive to periodic rotational stimulation and modulated with respect to head orientation (gravity) during constant velocity off-vertical axis rotation (47). The caudal vestibulo-recipient parabrachial nucleus may help detect anomalies in control of postural stability during locomotion and may also be involved with the malaise associated with mal de debarquement (47).

Voxel-based morphometry in 28 individuals with mal de debarquement syndrome and 18 age-, sex-, and handedness-matched controls identified grey matter volume differences between cases and controls, and among cases, as a function of illness duration (17). Differences were identified in visual-vestibular processing areas, somatosensory network structures, and a structure within the central executive network (ie, the dorsolateral prefrontal cortex).

In another study, 18F-FDG PET showed relative hypermetabolism in the occipital and prefrontal cortices and hypometabolism in the vestibulocerebellum (nodulus and uvula) among those with mal de debarquement syndrome (compared to those who were unaffected) (40). Analysis of functional connectivity of the significant regions in the PET scans revealed decreased connectivity between the prefrontal cortex and visual processing areas in the mal de debarquement group. Resting-state functional connectivities were significantly decreased between the vestibular regions of the flocculus, superior temporal gyrus, and parietal operculum and the visual association areas of the middle occipital gyrus, fusiform gyrus, and cuneus in participants with mal de debarquement syndrome (40).

Based on experiments in monkeys exposed to continuous rotation in darkness, coupled with side-to-side roll, Dai and colleagues reproduced some of the features of human mal de debarquement syndrome (26; 21). Through further experiments, these investigators linked alterations in the velocity storage integrator with development of mal de debarquement syndrome (21).

The basis for the female preponderance of cases is unclear, but a potential relation has been proposed between gonadal hormone fluctuations and symptom aggravation in the motion-triggered group (52).

Diagnostic workup

	• History and physical examination are usually sufficient; no diagnostic tests are required.
	• Diagnostic guidelines have been proposed for persistent mal de debarquement syndrome.

History and physical examination are usually sufficient; no diagnostic tests are required. However, largely because of physician unfamiliarity with this disorder, diagnosis is often delayed (45; 63; 49), and an average of 19 clinical visits is needed for patients to obtain a diagnosis (45).

Electronystagmography or video-oculography, including caloric testing, is generally normal when performed in cases of persistent mal de debarquement but may show abnormal tracking or direction-changing positional nystagmus (10; 55; 46; 40); the latter findings are nonlocalizing and of questionable significance, particularly because they may be present in approximately 10% of normal subjects (43). The video head impulse test, ocular and cervical vestibular-evoked myogenic potentials, rotatory testing, audiograms, brainstem auditory evoked responses, and cerebral imaging are also normal (or show incidental findings) (10; 55; 46; 40).

Diagnostic guidelines have been proposed for persistent mal de debarquement syndrome (63; 64):

	(a) Chronic perception of “rocking dizziness” (eg, rocking, bobbing, swaying) that began after passive motion (eg, sea, air, or land travel)
	(b) Persistent symptoms for at least 1 month
	(c) Normal inner ear function, or nonrelated abnormalities, as assessed by audiological tests and electronystagmography/videomystagmography
	(d) Normal structural brain imaging or nonspecific alterations on noncontrast MRI
	(e) Symptoms not better accounted for by another diagnosis

Management

	• Most cases with mal de debarquement resolve spontaneously over hours to days, and no further treatment beyond reassurance is necessary for the occasional patient who seeks medical care.
	• For persistent mal de debarquement, neither meclizine nor transdermal scopolamine have been helpful.
	• Counseling, cognitive behavioral therapy, as well as anxiolytic medications and SSRI/SNRI antidepressants are pragmatic therapies for persistent mal de debarquement and excessive anxiety.
	• Management of mal de debarquement as vestibular migraine can improve patients' symptoms and increase their quality of life.

Most cases with mal de debarquement resolve spontaneously over hours to days, and no further treatment beyond reassurance is necessary for the occasional patient who seeks medical care.

Chronic mal de debarquement has fluctuations that are both innate and driven by environmental stressors (15). Consequently, the therapeutic strategy is to provide counseling to manage expectations, identify and manage behavioral and lifestyle factors that exacerbate symptoms, employ cognitive-behavioral therapy, and utilize anxiolytic medications and SSRI/SNRI antidepressants as necessary to manage anxiety (11; 19; 54; 15).

For patients with more persistent or disabling symptoms, improvement in patient-reported outcomes has been reported with several different modalities, including pharmacologic management with neurotropic drugs, vestibular rehabilitation, and neuromodulating stimulation (41).

Benzodiazepines and SSRI/SNRI antidepressants have had anecdotal success with persistent mal de debarquement (55; 36; 11; 19), but because discontinuation of benzodiazepines may cause symptom exacerbation, these should be employed cautiously and for a limited time (55). Amitriptyline has also been reported to help assist recovery of persistent mal de debarquement (55). Neither meclizine nor transdermal scopolamine has been helpful for persistent mal de debarquement (10; 55; 36).

Formal vestibular rehabilitation has had limited success in this disorder (36; 12) and, in some cases, may produce a short-term exacerbation of symptoms before long-term improvement (55). Nevertheless, patients should be encouraged to avoid inactivity and, thus, actively participate in activities that may enhance readaptation such as walking (10; 55; 46). “Sensory reweighting,” using vestibular, somatosensory, and visual challenges twice a week over a 10-week period, has been reported to be helpful in a single case (44).

Management of mal de debarquement as vestibular migraine may improve patients' symptoms and increase their quality of life. In one study, 11 of 15 patients (73%) responded well to management with a vestibular migraine protocol, which included lifestyle changes, as well as pharmacotherapy with verapamil, nortriptyline, topiramate, or some combination, whereas, in comparison, a retrospective control group of 17 patients demonstrated a lower rate of improvement when treated with vestibular rehabilitation and physical therapy (30).

Dai and colleagues reported that “readaptation” of the vestibulo-ocular reflex produced either a cure or a substantial improvement in 70% of 24 subjects with persistent mal de debarquement syndrome for a period of approximately 1 year on average (27; 25). On the premise that maladapted rocking sensations and the associated physical symptoms could be diminished or eliminated by readapting the vestibulo-ocular reflex, subjects were treated by rolling the head from side to side while watching a rotating full-field stimulus. In a later study, Dai and colleagues reported the outcomes of 141 patients (122 females and 19 males) whose heads were rolled while watching a rotating full-field visual surround (24). Significant improvement was defined as a reduction in symptom severity by more than 50%. No objective measures were used during follow-up because of the wide geographic distribution of the patients. The treatment group consisted of 120 classic and 21 spontaneous mal de debarquement patients. The initial rate of significant improvement after a week of treatment was 78% in classic patients and 48% in spontaneous patients. One year later, significant improvement was maintained in 52% of classic and 48% of spontaneous subjects. There was complete remission of symptoms in 27% (32) of the classic and 19% (4) of the spontaneous patients. These results have been supported by a sham-controlled trial (51). This treatment paradigm has been replicated in a virtual reality environment, successfully resolving symptoms in two visits in a single case study (38).

References

01: Ampomah KK, Clark BC, Arnold WD, Burwell D. An uncommon cause of headache and dizziness after cruise travel: case report of mal de debarquement syndrome. J Osteopath Med 2021;121(5):471-4. PMID 33694342
02: Anonymous. Irwin, John Arthur. In: The national cyclopaedia of American biography: being the history of the United States as illustrated in the lives of the founders, builders, and defenders of the republic, and of the men and women who are doing the work and moulding the thought of the present time. Volume II. New York: James T White & Co., 1892:151.
03: Arnardottir NY, Jonsdottir SS, Petersen H. Seasickness among Icelandic seamen. PLoS One 2022;17(8):e0273477. PMID 36018861
04: Arroll MA, Attree EA, Cha YH, Dancey CP. The relationship between symptom severity, stigma, illness intrusiveness and depression in mal de debarquement syndrome. J Health Psychol 2016;21(7):1339-50. PMID 25331814
05: Bailey CF, Cagle GK, Grozier CD, et al. Gathering your 'sea legs': Extended durations in an offshore environment increases postural sway excursions. Gait Posture 2021;86:45-50. PMID 33677178
06: Beh SC, Chiang HS, Sanderson C. The interconnections of mal de débarquement syndrome and vestibular migraine. Laryngoscope 2021;131(5):E1653-61. PMID 33135784
07: Benson AJ. Possible mechanisms of motion and space sickness. Proceedings of the European Symposium on Life Sciences Research in Space. European Space Agency 1977;SP-130:101-8.
08: Berman CW. A case of mal de debarquement and panic disorder. CNS News 2005.
09: Brandt T. Phobic postural vertigo. Neurology 1996;46(6):1515-9. PMID 8649539
10: Brown JJ, Baloh RW. Persistent mal de debarquement syndrome: a motion-induced subjective disorder of balance. Am J Otolaryngol 1987;8:219-22. PMID 3631419
11: Canceri JM, Brown R, Watson SR, Browne CJ. Examination of current treatments and symptom management strategies used by patients with mal de debarquement syndrome. Front Neurol 2018;9:943. PMID 30483208
12: Cedras AM, Moin-Darbari K, Foisy K, et al. Questioning the impact of vestibular rehabilitation in mal de debarquement syndrome. Audiol Neurootol 2024;29(2):107-13. PMID 37820609
13: Cha YH. Mal de debarquement. Semin Neurol 2009;29(5):520-7. PMID 19834863
14: Cha YH. Less common neuro-otologic disorders. Continuum (Minneap Minn) 2012;18(5 Neuro-otology):1142-57. PMID 23042064
15: Cha YH. Chronic dizziness. Continuum (Minneap Minn) 2021;27(2):420-46. PMID 34351113
16: Cha YH, Brodsky J, Ishiyama G, Sabatti C, Baloh RW. Clinical features and associated syndromes of mal de debarquement. J Neurol 2008;255(7):1038-44. PMID 18500497
17: Cha YH, Chakrapani S. Voxel based morphometry alterations in mal de debarquement syndrome. PLoS One 2015;10(8):e0135021. PMID 26252893
18: Cha YH, Cui Y. Rocking dizziness and headache: a two-way street. Cephalalgia 2013;33(14):1160-9. PMID 23674832
19: Cha YH, Cui YY, Baloh RW. Comprehensive clinical profile of mal de debarquement syndrome. Front Neurol 2018;9:261. PMID 29867709
20: Christie A. Sleeping murder. New York: Bantam Books Inc., 1976:1-2.
21: Cohen B. Dedication to Mingjia Dai, Ph.D. for discovery of the first successful treatment of the mal de debarquement syndrome. Front Neurol 2019;10:1196. PMID 31920903
22: Cohen H. Vertigo after sailing a nineteenth century ship. J Vestib Res 1996a;6:31-5. PMID 8719507
23: Cohen H. Mild mal de debarquement after sailing. Ann NY Acad Sci 1996b;781:598-600. PMID 8694451
24: Dai M, Cohen B, Cho C, Shin S, Yakushin SB. Treatment of the mal de debarquement syndrome: a 1-year follow-up. Front Neurol 2017;8:175. PMID 28529496
25: Dai M, Cohen B, Smouha E, Cho C. Readaptation of the vestibulo-ocular reflex relieves the mal de debarquement syndrome. Front Neurol 2014;5:124. PMID 25076935
26: Dai M, Raphan T, Cohen B. Adaptation of the angular vestibulo-ocular reflex to head movements in rotating frames of reference. Exp Brain Res 2009;195(4):553-67. PMID 19458941
27: Dai M, Raphan T, Cohen B. Prolonged reduction of motion sickness sensitivity by visual-vestibular interaction. Exp Brain Res 2011;210(3-4):503-13. PMID 21287155
28: Darwin E. Of vertigo. In: Zoonomia. The laws of organic life. Volume 1. London, 1796:178-9.
29: Flanagan MB, May JG, Dobie TG. Sex differences in tolerance to visually-induced motion sickness. Aviat Space Environ Med 2005;76(7):642-6. PMID 16018346
30: Ghavami Y, Haidar YM, Ziai KN, et al. Management of mal de debarquement syndrome as vestibular migraines. Laryngoscope 2017;127(7):1670-5. PMID 27730651
31: Gordon CR, Shupak A, Nachum Z. Mal de debarquement. Arch Otolaryngol Head Neck Surg 2000;126:805. PMID 10864126
32: Gordon CR, Spitzer O, Doweck I, Melamed Y, Shupak A. Clinical features of mal de debarquement: adaptation and habituation to sea conditions. J Vestib Res 1995;5:363-9. PMID 8528477
33: Gordon CR, Spitzer O, Shupak A, Doweck I. Survey of mal de debarquement. BMJ 1992;304:544. PMID 1559057
34: Groen JJ. Problems of the semicircular canal from a mechanico-physiological point of view. Acta Otolaryngol 1960;163:59-66. PMID 13708855
35: Hain TC. Mal de debarquement: in reply. Arch Otolaryngol Head Neck Surg 2000;126:805-6.
36: Hain TC, Hanna PA, Rheinberger MA. Mal de debarquement. Arch Otolaryngol Head Neck Surg 1999;125:615-20. PMID 10367916
37: Homick JL, Reschke MF, Miller EP. The effects of prolonged exposure to weightlessness on postural equilibrium. In: Proceedings of the Skylab Life Sciences Symposium. Report TMX-58154. Vol 1. Houston, TX: NASA, 1974:221-8.
38: Hoppes CW, Vernon M, Morrell RL, Whitney SL. Treatment of mal de debarquement syndrome in a computer-assisted rehabilitation environment. Mil Med 2022;187(7-8):e1011-5. PMID 33604663
39: Irwin JA. The pathology of sea-sickness. Lancet 1881;2:907-9.
40: Jeon SH, Park YH, Oh SY, et al. Neural correlates of transient mal de debarquement syndrome: activation of prefrontal and deactivation of cerebellar networks correlate with neuropsychological assessment. Front Neurol 2020;11:585. PMID 32695063
41: Kinkhabwala CM, Yuen E, Brennan E, Cadena A, Rizk HG. Treatment options in mal de débarquement syndrome: a scoping review. Otol Neurotol 2023;44(4):e197-203. PMID 36791362
42: Lewis RF. Frequency-specific mal de debarquement. Neurology 2004;63(10):1983-4. PMID 15557538
43: Lin J, Elidan J, Baloh RW, et al. Direction-changing positional nystagmus: incidence and meaning. Am J Otolaryngol 1986;7:306-10. PMID 3489418
44: Liphart J. Use of sensory reweighting for a woman with persistent mal de debarquement: a case report. J Geriatr Phys Ther 2015;38:96-103. PMID 24978933
45: Macke A, LePorte A, Clark BC. Social, societal, and economic burden of mal de debarquement syndrome. J Neurol 2012;259(7):1326-30. PMID 22231864
46: Mair IW. The mal de debarquement syndrome. J Audiol Med 1996;5:21-5.
47: McCandless CH, Balaban CD. Parabrachial nucleus neuronal responses to off-vertical axis rotation in macaques. Exp Brain Res 2010;202:271-90. PMID 20039027
48: Melvill Jones C. Adaptive neurobiology in space flight. In: Proceedings of the Skylab Life Sciences Symposium. Report TMX-58154. Vol. 2. Houston, TX: NASA, 1974:847-59.
49: Memon SF, Khan AA, Mohiuddin O, Memon SA. Mal de debarquement syndrome: a rare entity. Cureus 2020;12(2):e6837. PMID 32175204
50: Moeller L, Lempert T. Mal de debarquement: pseudo-hallucinations from vestibular memory. J Neurol 2007;254:813-5. PMID 17401743
51: Mucci V, Canceri JM, Brown R, et al. Mal de debarquement syndrome: a survey on subtypes, misdiagnoses, onset and associated psychological features. J Neurol 2018a;265(3):486-99. PMID 29305644
52: Mucci V, Canceri JM, Brown R, et al. Mal de debarquement syndrome: a retrospective online questionnaire on the influences of gonadal hormones in relation to onset and symptom fluctuation. Front Neurol 2018c;9:362. PMID 29910765
53: Mucci V, Canceri JM, Jacquemyn Y, et al Pilot study on patients with mal de debarquement syndrome during pregnancy. Future Sci OA 2019;5(4):FSO377. PMID 31114703
54: Mucci V, Perkisas T, Jillings SD, et al. Sham-controlled study of optokinetic stimuli as treatment for mal de debarquement syndrome. Front Neurol 2018b;9:887. PMID 30410464
55: Murphy TP. Mal de debarquement syndrome: a forgotten entity. Otolaryngol Head Neck Surg 1993;109:10-3. PMID 8336953
56: Nachum Z, Shupak A, Letichevsky V, et al. Mal de debarquement and posture: reduced reliance on vestibular and visual cues. Laryngoscope 2004;114(3):581-6. PMID 15091239
57: Ramesh S, Ben-Dov T, April MM, Cho C. Mal de Débarquement syndrome in children: a case series. J Pediatr 2023;259:113435. PMID 37088179
58: Reason JT. Motion sickness adaptation: a neural mismatch model. J Royal Soc Med 1978;71:819-29. PMID 731645
59: Riley J, Gleghorn D, Doudican BC, Cha YH. Psychological assessment of individuals with Mal de Débarquement Syndrome. J Neurol 2022;269(4):2149-61. PMID 34541614
60: Scott JR. Adaptation to nauseogenic motion stimuli and its application in the treatment of air sickness. In: GH Crampton. Motion and space sickness. CRC Press, 1990:373-90.
61: Tal D, Domachevsky L, Bar R, Adir Y, Shupak A. Inner ear decompression sickness and mal de debarquement. Otol Neurotol 2005;26:1204-7 PMID 16272943
62: Teitelbaum P. Mal de debarquement syndrome: a case report. J Travel Med 2002;9:51-2. PMID 11953264
63: Van Ombergen A, Van Rompaey V, Maes LK, Van de Heyning PH, Wuyts FL. Mal de debarquement syndrome: a systematic review. J Neurol 2016a;263(5):843-54. PMID 26559820
64: Van Ombergen A, Wuyts FL, Cha YH. Letter to the Editor: comment and erratum to "Mal de debarquement syndrome: a systematic review". J Neurol 2016b;263(5):855-60. PMID 27067708
65: Young AS, Nham B, Bradshaw AP, et al. Clinical, oculographic, and vestibular test characteristics of vestibular migraine. Cephalalgia 2021;41(10):1039-52. PMID 33938251

Patient Profile

Age range of presentation: 6 years to 65+ years
Sex preponderance: female>male, >2:1
Heredity: none
Population groups selectively affected: none selectively affected
Occupation groups selectively affected: sailors

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Mal de debarquement

Differential Diagnosis

motion sickness
phobic positional vertigo syndrome

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Cyclic vomiting syndrome
Motion sickness
Nausea and vomiting
Phenytoin

Mal de debarquement …

Mal de debarquement

Introduction

Overview

Key points

Historical note and terminology

Clinical manifestations

Presentation and course

Prognosis and complications

Clinical vignette

Biological basis

Etiology and pathogenesis

Epidemiology

Prevention

Differential diagnosis

Diagnostic workup

Management

Special considerations

Pregnancy

Media

References

Contributors

Author

Patient Profile

ICD & OMIM codes

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Mal de debarquement

Introduction

Overview

Key points

Historical note and terminology

Clinical manifestations

Presentation and course

Prognosis and complications

Clinical vignette

Biological basis

Etiology and pathogenesis

Epidemiology

Prevention

Differential diagnosis

Diagnostic workup

Management

Special considerations

Pregnancy

Media

References

Contributors

Author

Patient Profile

ICD & OMIM codes

This is an article preview. Start a Free Account to access the full version.

Questions or Comment?

Also in This Category

Toxic and nutritional deficiency optic neuropathies

Third nerve palsy

Nystagmus

Brain death/death by neurologic criteria

Hormonal contraception and stroke

Hepatic encephalopathy

Cervical spondylotic myelopathy

Bowel dysfunction in neurologic disorders

This is an article preview.
Start a Free Account
to access the full version.