The Barany Society and the Classification Committee of the Barany Society (CCBS) have created diagnostic criteria for Mal de Débarquement Syndrome (MdDS) with the goal of creating common terminology for diagnosis and research. These criteria will be included in the International Classification of Vestibular Disorders (ICVD).
Vestibular disorders can be due to functional alterations within the central nervous system without a concurrent structural injury, so it is important to determine the differences between Mal de Débarquement Syndrome and other similar functional vestibular disorders.
Mal de Débarquement Syndrome has appeared in the medical literature for over 300 years with individuals describing symptoms as non-spinning vertigo, dizziness, and imbalance after sea voyages.
In March 2017, the CCBS introduced a format for developing criteria for Mal de Débarquement Syndrome. In June 2018, a committee of international specialists was formed and drafted criteria. The draft was presented to CCBS members in June 2019, and then the completed criteria were presented to the Barany Society membership in January 2020.
In terms of diagnostic criteria, there are differences between short-term land-sickness lasting less than 48 hours and the syndrome lasting beyond 48 hours. Therefore, the criteria created constitute the disorder of Mal de Débarquement Syndrome:
- Non-spinning vertigo characterized by an oscillatory perception (‘rocking,’ ‘bobbing,’ or ‘swaying’) present continuously or for most of the day
- Onset occurs within 48 hours after the end of exposure to passive motion
- Symptoms temporarily reduce with exposure to passive motion
- Symptoms continue for >48 hours
- MdDS in evolution: symptoms are ongoing but the observation period has been less than 1 month
- Transient MdDS: symptoms resolve at or before 1 month and the observation period extends at least to the resolution point
- Persistent MdDS: symptoms last for more than 1 month
- Symptoms not better accounted for by another disease or disorder
MdDS is frequently misdiagnosed as other disorders in the general medical community. It is significantly represented in women with onset peak between 40–49 years. More than one lifetime episode of MdDS can occur with subsequent episodes usually lasting longer than previous episodes and a decreased chance of a spontaneous recovery.
Symptom severity can fluctuate due to multiple factors, including stress, sleep deprivation, and hormonal factors. The vertigo of MdDS persists in different body positions. Common additional symptoms include sensations of spatial disorientation, fatigue, visual motion intolerance, headaches, and anxiety.
Diagnosis is based on clinical history alone. There are no findings on physical examination, laboratory testing, or imaging that are indicative of MdDS. Differential diagnoses include vestibular migraine, motion sickness, and persistent postural perceptual dizziness.
Future research investigations are required to bring into line foundations of MdDS with ICVD nomenclature and to more clearly identify its differences from similar disorders.
Creating a uniform set of diagnostic criteria for MdDS would improve accuracy of diagnosis in order to apply the appropriate treatment strategies in a timely manner.
Source: Cha, Y., Baloh, R. W., Cho, C., Magnusson, M., Song, J., Strupp, M., Wuytsg, F., Staab, J. P. (2020). Mal de débarquement syndrome diagnostic criteria: Consensus document of the Classification Committee of the Bárány Society. Journal of Vestibular Research, 30(5), 285-293. doi:10.3233/ves-200714
Summary written by Sonia Vovan, MPT