Clinical features and associated syndromes of mal de debarquement

Objective: To investigatethe clinical features and naturalhistory of mal de debarquement(MdD). Design: Retrospective casereview with follow-up questionnaireand telephone interviews. Setting: University Neurotology Clinic. Patients: Patients seen between1980 and 2006 who developed apersistent sensation of rocking orswaying for at least 3 days after exposureto passive motion. Main outcome measure: Clinical features,diagnostic testing, and questionnaireresponses. Results: Of 64 patients(75 % women) identifiedwith MdD, 34 completed follow-upquestionnaires and interviews in2006. Most patients had normalneurological exams, ENGs andbrain MRIs. The average age of thefirst MdD episode was 39 ± 13years. A total of 206 episodes wereexperienced by 64 patients. Ofthese, 104 episodes (51 %) lasted > 1 month; 18 %, > 1 year; 15 %, > 2years; 12 %, > 4 years, and 11 %, > 5years. Eighteen patients (28 %) subsequentlydeveloped spontaneousepisodes of MdD-like symptomsafter the initial MdD episode.There was a much higher rate ofmigraine in patients who went onto develop spontaneous episodes(73 %) than in those who did not(22 %). Subsequent episodes werelonger than earlier ones in mostpatients who had multiple episodes.Re-exposure to passivemotion temporarily decreasedsymptoms in most patients (66 %).Subjective intolerance to visualmotion increased (10 % to 66 %)but self-motion sensitivity did not(37 % to 50 %) with onset of MdD. Conclusion: The majority of MdDepisodes lasting longer than 3 daysresolve in less than one year but theprobability of resolution declineseach year. Many patients experiencemultiple MdD episodes. Somepatients develop spontaneousepisodes after the initial motiontriggeredepisode with migrainebeing a risk factor.