A 27-year-old Female With Mal De Debarquement Syndrome Is Treated Using A Novel Brain-based And Vestibular Approach To Near Full Resolution Of Symptomatology
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Dr. Shannon Leon Functional Neurology, United States
Background
Mal de Debarquement Syndrome (MdDS) is a neurological condition characterized by perceived self-motion persisting longer than one month, most commonly following exposure to passive motion (e.g. cruise, flight, etc), however there are reported cases of spontaneous or other onset. A 27-year-old female presents to our functional neurology clinic with diagnosis of MdDS. Patient reports that following a five-hour ferry ride six months ago she has retained persistent symptoms of perceptual rocking and bobbing; comorbidities include left-sided vestibular neuritis secondary to sinus infection, vestibular migraines, shortness of breath, high anxiety, and depression. Patient reports physical and emotional inability to hear water-based sounds (running faucet, waves on the beach, etc.) and to travel on boats or airplanes without accentuation of MdDS symptoms. Previous vestibular rehabilitation therapy was ineffective, and the only improvement in primary symptoms occurs while riding in a car.
Methods
Due to systemic nature of the human vestibular system responsible for the perception of gravity a complete neurological examination is required. Vital signs were as follows: blood pressure seated 130/79 in right, 119/83 in left, and standing is 132/83 in right; heart rate in beats per minute while seated is 87 in right, 88 in left, and while standing is 80 in right; oxygen saturation upper distal extremities is 100% bilateral. Bedside neurological examination reveals right internally rotated upper extremity, right ocular hypertropia, leftward hypermetric saccades, right pyramidal paresis, right hypermetric finger to nose, right alternating hand movements are dysdiadochokinetic and dyspraxic, right sided decrease in vibration sense, left increase of palpebral fissure, resting tremor of head rates 1 on TETRAS scale, left upper extremity deep tendon reflex spreading, resting nystagmus fast phase right and down, shortened eccentric gaze fixation times left horizontal, right vertical, and left vertical. Dynamic posturography confirms decrease stability within bilateral posterior semicircular canals, bilateral otolithic organs, and left horizontal semicircular canal. Videonystagmography confirms bilateral accommodation spasms in the dark, bilateral vestibulo-ocular reflexes are within normal limits, however both reflexes exhibit rightward post-rotational nystagmus. Based upon current patient presentation, our clinic prescribed a brain-based, multimodal treatment plan that included vestibular rehabilitation maneuvers, vestibulo-ocular re-training, specific eye movement therapies, and personalized plant-based nutrition plan.
Results
Following initial treatment patient reports “overall steadier” with improved balance and gait stability, and reports back on second visit that “for the first time in a long time” she slept soundly through the night. Patient was seen twice per week for the first month, and once per week ongoing to present day. At present, ten months following initial visit to our clinic, patient reports MdDS symptoms to be over 90% attenuated. Her ongoing care seeks to identify potential confounding environmental factors while further rehabilitating integrity of neurological integration. Patient enjoys full emotional return to water-based sounds and to travel aboard boats and airplanes.
Conclusion
The human nervous system recruits systemic networks for perceiving gravity and faithfully reacting to it, and myopic neurological examination cannot be tolerated if the patient and clinician seek complete knowledge of presenting phenomenology and pathology. A 27-year-old female presents to our functional neurology clinic with diagnosis of MdDS, and she sees immediate attenuation of symptomatology with a continued trend toward optimal health using a brain-based, multimodal treatment approach. Further investigation is warranted for interventions involving brain-based therapies for Mal de Debarquement Syndrome and other systemic disorders.
Keywords:
Mal de Debarquement Syndrome (MdDS),
Vestibular Diseases,
Brain Based Rehabilitation,
novel strategies,
Brain
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Leon
S,
Langhough
J and
Case
M
(2018). A 27-year-old Female With Mal De Debarquement Syndrome Is Treated Using A Novel Brain-based And Vestibular Approach To Near Full Resolution Of Symptomatology.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00059
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Received:
30 Mar 2018;
Published Online:
14 Dec 2018.
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Correspondence:
Dr. Jason Langhough, Dr. Shannon Leon Functional Neurology, Woodbury, NY, 11797, United States, j.langhough@gmail.com