Motorist Disorientation Syndrome

view of the meadow from a car.

By Christine Strange, AuD

Motorist Disorientation Syndrome⁽¹⁾ (MDS) also referred to as Motorist’s Vestibular Disorientation Syndrome ⁽²⁾ are terms proposed to describe spatial disorientation (SD) specifically experienced when driving an automobile.  Spatial awareness is primarily the result of the integration of proprioception (allows us to perceive the position and movement of our body parts)  as well as the visual and vestibular systems. SD can occur due to impairment in one or more of these systems or in the complex processes that synthesize these sensory inputs. The activity of driving or flying introduces elements that exceed natural physical activities, such as increased speed of motion, increased speeds of changing visual environment and alterations of proprioceptive cues and these elements can induce or exacerbate SD in individuals with or without defined vestibular disorder ^(3,4).  SD associated with flying has been extensively studied and the effects on the normal vestibular system and associated misperceptions of motion are well recognized and understood.(4) There are few studies, however, that address similar type symptoms experienced by motorists. 

The symptoms associated with MDS have been consistently reported across multiple studies over the last several decades and include veering, the illusion of motion when at rest, tilt or rolling over, and difficulty on steep hills^(1,2,3,5). 

The perception of  the vehicle veering or pulling to one side may be prompted by either a lack of visual references such as trees or buildings while driving a distance on an open road or can occur when large trucks are passing that momentarily limit the visual field. This feeling of veering can be so convincing that the driver may suspect the problem is due a malfunction of the vehicle.⁽²⁾  

A perception of motion can occur when the vehicle is stationary and the traffic in the adjacent lane begins to move, which, like veering, involves a conflict in visual and vestibular cues. Rounding a corner, particularly at higher speeds, can result in the perception of tilt or vehicle roll over. 

Lastly, misperception of angle or difficulty when driving over a hill may be related to the brief loss of visual cues when cresting the hill and/or proprioceptive changes related to postural changes that occur as the result of the incline or decline⁽²⁾. Symptoms can be triggered by speed and other environmental factors including poor lighting, weather conditions, and familiarity of the road/route.  

There are conflicting data regarding the prevalence of abnormal vestibular test results in this patient population. Treatments including medications, vestibular physical therapy, as well as cognitive behavioral therapy have been reported to have success in reducing or resolving symptoms provoked by driving. 

There are several visual/vestibular disorders that have overlapping symptoms such as persistent postural perceptual vertigo (PPPD), vestibular migraine, and Mal de Debarquement Syndrome and others. However, MDS has been suggested as a distinct and separate disorder when symptoms are specifically provoked by driving and do not meet the criteria of other established disorders^(1,2,3,5). However, further research is needed to explore the symptom and diagnostic profile proposing MDS as a unique disorder versus a subset of other established disorders. 

References:

1. Ainsworth, C., Davies, R., Colvin, I., & Murdin, L. (2023). Motorist disorientation syndrome; clinical features and vestibular findings. Journal of vestibular research : equilibrium & orientation, 33(5), 339–348. https://doi.org/10.3233/VES-220088
2. Page, N. G., & Gresty, M. A. (1985). Motorist’s vestibular disorientation syndrome. Journal of neurology, neurosurgery, and psychiatry, 48(8), 729–735. https://doi.org/10.1136/jnnp.48.8.729
3. Bronstein, A. M., Golding, J. F., & Gresty, M. A. (2020). Visual Vertigo, Motion Sickness, and Disorientation in Vehicles. Seminars in neurology, 40(1), 116–129. https://doi.org/10.1055/s-0040-1701653
4. Demir AE, Aydın E. Vestibular Illusions and Alterations in Aerospace Environment. Turk Arch Otorhinolaryngol. 2021;59(2):139-149. doi:10.4274/tao.2021.2021-3-3
5. Pawar, V., Ashraf, H., Dorsala, S., Mary, P., Hameed, N., H, D. N., Adatia, S. P., Raj, L., Ananthu, V. R., & Shouka, M. (2023). Motorist’s Vestibular Disorientation Syndrome (MVDS)-Proposed Diagnostic Criteria. Journal of personalized medicine, 13(5), 732. https://doi.org/10.3390/jpm13050732