FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER “CAME ASHORE” BUT STILL FEELS LIKE SHE’S “ON THE BOAT”

Question: I’ve been diagnosed with Mal de Debarquement Syndrome.  I got it after I came back from an ocean cruise.  So far, treatment for it has not been successful.  This is a strange disorder in which symptoms are with you constantly; they never leave.  You feel like you’re constantly trying to walk on a mattress or trampoline.  Can you tell me what causes this disorder and if there’s any way to cure it?

Answer: Mal de Debarquement syndrome (MDDS) is a very rare disorder, which most commonly strikes women between the ages of 40 and 50. While I am sorry to hear that you have MDDS, you are lucky to have a diagnosis. Many sufferers go from doctor to doctor before they find one who is aware of this disorder and can correctly diagnose it.

The constant motion symptoms of Mal de Debarquement syndrome are usually first noticed, as in your case, when a person returns to land after an ocean cruise. That is, it comes on after you come ashore, or disembark, from a ship.

The most common symptoms are rocking, swaying, bobbing and floating sensations. These may be accompanied by other manifestations of a constant feeling of motion as well as fatigue, an unsteady gait (ataxia) and difficulty concentrating.

These symptoms can also be seen with certain inner-ear disorders such as Ménière’s disease. Therefore, your doctor will need to exclude these diseases before arriving at a diagnosis of MDDS.

Most people have a brief period of adjustment to being on land after being on the high seas for several days. With MDDS, you never get your “land legs” back -- the feeling that you are still rocking on the boat never leaves. MDDS has also been diagnosed following air or train travel.

The underlying cause continues to elude physicians. It is not caused by a problem with the “balance center” in the inner ear. It is believed to be caused by a change in the balance part of the brain. Some speculate that it is actually a type of migraine headache.

The symptoms get better with motion, such as driving a car and are worse when you are still, like trying to get to sleep at night. Some people report a worsening of symptoms when they are under stress, are feeling tired, have another illness or are in crowded areas like malls, busy stores or offices.

Most people recover from this syndrome in less than a month. In a few cases, however, it can last much longer. Some unlucky folks have suffered with MDDS for ten years or more.

The treatments that we use for dizziness do not work in MDDS. Treatments that have been helpful include non-steroidal anti-inflammatory drugs, some anti-seizure medications like Dilantin and certain tranquilizers. Amitriptyline, an anti-depressant sold under brand names Elavil and Endep, has helped some people as well.

Vestibular rehabilitation therapy, physical therapy and exercise has helped some sufferers. Ultimately, more research needs to be done so that the exact cause and, thus, more appropriate and specific treatments, can be found.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.