Mal de debarquement

Douglas J Lanska MD FAAN MS MSPH (Dr. Lanska of the Great Lakes VA Healthcare System and the University of Wisconsin School of Medicine and Public Health has no relevant financial relationships to disclose.)
Originally released September 25, 2001; last updated January 29, 2017; expires January 29, 2020

This article includes discussion of mal de debarquement, land sickness, and sickness of disembarkment. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The author explains the clinical presentation, pathophysiology, diagnostic workup, and management of mal de debarquement syndrome. Mal de debarquement is an inappropriate sensation of movement after termination of motion that is accompanied by disequilibrium, but not vertigo. Mal de debarquement is usually experienced after a sea voyage, and middle-aged women seem to be particularly susceptible to persistent symptoms of mal de debarquement. In a study, Dai and colleagues provided evidence that readaptation of the vestibulo-ocular reflex can produce a high rate of cure or substantial relief in patients with persistent mal de debarquement syndrome.

Key points

 

• Mal de debarquement is an inappropriate sensation of movement after termination of motion that is accompanied by disequilibrium, but not vertigo, usually experienced after a sea voyage. The term “persistent mal de debarquement” is reserved for cases lasting 1 month or more.

 

• Symptoms of mal de debarquement include sensations of rocking, swaying, swinging, unsteadiness, and disequilibrium.

 

• Neurologic examination is generally normal in both mal de debarquement and persistent mal de debarquement. History and physical examination are usually sufficient, and no diagnostic tests are required.

 

• Mal de debarquement is distinct from motion sickness because subjects experience symptoms following termination of motion, rather than during the period of motion.

 

• Although most cases resolve spontaneously, middle-aged women seem to be particularly likely to experience protracted symptoms following an ocean cruise, with persistence of symptoms for many years.

 

• On the premise that maladapted rocking sensations and the associated physical symptoms could be diminished or eliminated by readapting the vestibulo-ocular reflex, rolling the head from side to side while watching a rotating full-field stimulus produced either a cure or a substantial improvement in 70% of subjects with persistent mal de debarquement syndrome for a period of approximately 1 year on average.

Historical note and terminology

In 1796, English physician Erasmus Darwin (1731–1802), the grandfather of naturalist Charles Darwin (1809–1882), gave an early description of mal de debarquement syndrome:

Image: English physician Erasmus Darwin (1792)

 

Those, who have been upon the water in a boat or ship so long, that they have acquired the necessary habits of motion upon that unstable element, at their return on land frequently think in their reveries, or between sleeping and waking, that they observe the room, they sit in, or some of its furniture, to librate like the motion of the vessel. This I have experienced myself, and have been told, that after long voyages, it is some time before these ideas entirely vanish. The same is observable in a less degree after having travelled some days in a stage coach, and particularly when we lie down in bed, and compose ourselves to sleep; in this case it is observable, that the rattling noise of the coach, as well as the undulatory motion, haunts us (Darwin 1796).

In 1881, Irish-American physician John Arthur Irwin (1853–1912) noted that sailors gradually adapt to the motion of a ship and that this adaptation may prove problematic on returning to land:

Image: Irish-American physician John Arthur Irwin (1853–1912)

 

Upon the ocean habit teaches the [semicircular] canals to adapt themselves to the new condition of things, and to pass over unheeded erroneous impressions which were noticed at first. In fact, the new habit may become so strong that a disturbance of it, by a return to land, will be marked by a similar phenomenon; hence the unsteady gait sometimes observable in a not-drunken sailor during his first few hours on shore after a long and stormy voyage (Irwin 1881; Anonymous 1892).

English crime novelist Agatha Christie (1890–1976) also described this phenomenon in her novel Sleeping Murder:

 

Gwenda Reed stood, shivered a little, on the quayside. The docks and the custom sheds and all of England that she could see were gently waving up and down…She had only just got off that heaving, creaking boat (it had been an exceptionally rough three days through the Bay and up to Plymouth)…On the following morning…the universe in general was no longer waving and wobbling. It had steadied down… (Christie 1976).

Mal de debarquement is an inappropriate sensation of movement after termination of motion that is accompanied by disequilibrium, but not vertigo. Mal de debarquement is usually experienced after a sea voyage (Irwin 1881; Brown and Baloh 1987; Gordon et al 1992; Gordon et al 1995; Murphy 1993; Cohen 1996a; Cohen 1996b; Mair 1996; Hain et al 1999; Teitelbaum 2002; Berman 2005; Tal et al 2005; Van Ombergen et al 2016a; Van Ombergen et al 2016b), but can also occur following other means of conveyance, such as car travel, train travel, air travel, or space travel (Homick et al 1974; Melvill Jones 1974; Benson 1977; Brown and Baloh 1987; Scott 1990; Murphy 1993; Hain et al 1999). Mal de debarquement is distinct from motion sickness because subjects experience symptoms following termination of motion, rather than during the period of motion, and subjects with mal de debarquement do not commonly have associated nausea, vomiting, diaphoresis, or headache (Mair 1996; Hain et al 1999).

Some authors consider mal de debarquement to encompass cases with transient (less than 48 hours) symptoms (Gordon et al 1992; Gordon et al 1995). Others refer to transient symptom cases as "land sickness" and reserve the term "mal de debarquement" for cases with symptoms with duration of at least 1 month (Brown and Baloh 1987; Hain et al 1999). Others have proposed that “mal de debarquement” be used for transient symptoms, and “mal de debarquement syndrome” be used for persistent symptoms lasting 1 month or more (Van Ombergen et al 2016a), but the use of the term “syndrome” to distinguish only a long duration of symptoms is really a misuse of the term and is less descriptive than simply saying persistent mal de debarquement. In this review, mal de debarquement and land sickness are considered to be synonymous and to encompass both transient and persistent symptoms following sea, air, or land travel; the term "persistent mal de debarquement" is reserved for cases lasting 1 month or more.

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