BRIEF RESEARCH REPORT article
Front. Neurol.
Sec. Neuro-Otology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1648253
This article is part of the Research TopicMechanisms of Functional Dizziness: A Window for Understanding Space-Motion CognitionView all 4 articles
Potential Lesson from a Model-Based Exploration on Treatment Effect Heterogeneity of Mal de Débarquement Syndrome
Provisionally accepted
- 1Icahn School of Medicine at Mount Sinai, New York, United States
- 2NYU Grossman School of Medicine, New York, NY, United States
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Background: A central vestibular neural mechanism known as velocity storage may be inappropriately conditioned in mal de débarquement syndrome (MdDS), a rare chronic vestibular disorder with a continuous false sensation of self-motion described as non-spinning vertigo. Visual-vestibular therapy approaches designed to recondition the three-dimensional properties of velocity storage have yielded much clinical success but not without limitations. An alternative therapeutic approach, designed to attenuate the contribution of malfunctioning velocity storage in higher-order neural processing, has also yielded positive results, but at a lower success rate. We sought a possible explanation for the latter shortcoming using a mathematical model. Methods: The three-dimensional orientation properties of velocity storage can be modeled as a dynamical system using a 3×3 system matrix. For normal upright, the system matrix is diagonal, with its eigenvectors aligning with the head-fixed roll, pitch, and yaw axes, and the yaw eigenvector with gravity. A pull sensation of MdDS has been expressed with a system matrix with off-diagonal elements representing cross-axis coupling and interpreted as a misalignment between the yaw eigenvector and the head vertical. We manipulated velocity storage's yaw time constant and output weight. Results: The model predicted that attenuating the velocity storage contribution could exaggerate the pull sensation. Conclusion: The present model-based exploration points to a possible weakness in the MdDS treatment approach focused on velocity storage attenuation while likely beneficial otherwise. When a pulling sensation is present, the treatment protocol may need to be supplemented with another approach that specifically counters this problem, such as optokinetic stimulation.
Keywords: Central vestibular disorder, Dizziness, gravity, Imbalance, optokinetic, Orientation vector, vestibular habituation, vestibulo-ocular reflex
Received: 16 Jun 2025; Accepted: 16 Sep 2025.
Copyright: © 2025 Maruta, Yakushin and Cho. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jun Maruta, jmaruta@braintrauma.org
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