Early Success in Treatment of MdDS with Virtual Reality
Authors: Hun Choi, Jung; Shenfeld, Galina; Heublum, Michael, MD; Shin, Miseon; Busso, Maria; Shenfeld, Jeffrey, MD
Balance and Dizziness Center in Palisades Park New Jersey – 17 Brinkerhoff Terrace Suite 201, Palisades Park, NJ 07650
Mal de debarquement syndrome (MdDS) is a condition in which an individual senses the subjective perception of motion-sickness, rocking, or swaying, after exposure to passive motion, such as air or sea travel.1 The underlying mechanism leading to symptoms in this rare condition is poorly understood, leading to frequent misdiagnosis. Furthermore, when correctly identified, treatment options at this time are poorly limited.
The pathogenesis and treatment options of MdDS are poorly understood. The purpose of this abstract is to highlight early success in the identification and treatment of MdDS at the Balance and Dizziness Center, an outpatient neurology clinic.
Patients aged 23 to 57 with clinical evidence of MdDS were treated using vestibular treatment software from Virtualis combined with HTC Vive Pro virtual reality goggles. Prior to treatment, all patients underwent vestibular diagnostics with vestibular nystagmography, calorics vestibular evoked myogenic potential, auditory brainstem response, and general neurological evaluation to rule out vestibular disorders and other comorbidities. Subjective surveys were used to assess both pre-treatment and post-treatment symptoms. Treatment consisted of one hour sessions over three consecutive days. Each session was made up of two to three minutes of treatment with two to three minutes of rest between treatments. Physical movement was measured via Romberg tests. Treatment was tailored using the Fukuda stepping test to determine specific treatment modalities. Response to treatment was measured via direct responses from patients using a set of questions. Romberg and Fukuda tests were performed after each session to measure objective responses to treatment.
Seven patients were treated using customized modalities. Prior to treatment, three patients reported physical swaying. Four patients reported a non-visible, internal sensation of motion. The duration of symptoms ranged from three months to seven years. The patients experienced varying intensities of symptoms dependent on a number of factors, including weather and psychosocial stress. Of note, all seven patients had previously tried various forms of vestibular therapy, with persistence of symptoms despite the various treatment modalities. All seven patients underwent virtual reality treatment. Treatment sessions were individually modified in real time in response to clinical changes. Three patients (43%) reported a 90% decrease in symptoms after four sessions. One patient (14%) reported a 100% decrease in all symptoms, though symptoms returned after a few days. One patient (14%) reported intermittent improvement in symptoms. One patient (14%) did not tolerate the treatment due to nausea. One patient (14%) reported no change in symptoms.
This limited data shows that after just a few sessions of virtual reality therapy, there was significant success in diminishing symptoms associated with MdDS. Given the complexity of treating this poorly-understood condition, these early results show the potential promise of this non-invasive therapy. Additional use and refinement of virtual reality therapy for MdDS will enable an optimized treatment approach, and crucial symptom relief for patients suffering with this condition.
1. Van Ombergen, Angelique, et al. “Mal De Debarquement Syndrome: A Systematic Review.” Journal of Neurology, vol. 263, no. 5, 2015, pp. 843–854., https://doi.org/10.1007/s00415-015-7962-6.