Mal de debarquement syndrome, also commonly referred to as disembarkment syndrome, is a neurological condition typically presenting after a cruise, flight or another event involving prolonged motion. Mal de débarquement is a French phrase translated as illness of disembarkment. Diagnosis of Disembarkment Syndrome (MdDS) is often provided by a neurologist or ENT (ear, nose and throat) specialist after an individual complains of a continuous sensation of swaying, rocking or bobbing. There are a few linked symptoms with most of them being typical vestibular disorders such as imbalance, unsteadiness, visual-motion sensitivity, brain fog and anxiety. The most reported onset of MdDS happens due to passive motion exposure. Individuals suffering from this type of onset are being denoted as Motion-Triggered (MT) MdDS patients. As most of the vestibular testing proves to come out as negative, doctors can be baffled while attempting the diagnosis. MdDS cannot be explained by the brain, nor the inner ear pathology, and it most commonly is an answer to a major trigger although it can also occur spontaneously. This syndrome varies from a highly common condition known as the "land sickness", which is experienced for a short period after a car ride, cruise, aircraft flight or even a treadmill exercise with the duration ranging from a few minutes to a few hours. Since 2020, the syndrome is gaining more attention due to an increasing number of individuals suffering from this condition and more scientific input has started to determine the triggers and treatment for MdDS.

Who is mostly affected?

MdDS mostly affects female subjects (85% of the clinical population), with onset generally starting between 40-50 years of age. Males can also be affected, although they represent only 10-15% of the MdDS clinical population. Disembarkment Syndrome often affects individuals in their 30s to 50s however, it is less commonly seen in children and older adults. People who have been exposed to environments with prolonged motion are more likely to develop Disembarkment Syndrome including individuals who have been on extended boat or cruise trips, long-haul flights or virtual reality simulations might be at a higher risk of experiencing this condition. There appears to be a connection between Disembarkment Syndrome and individuals who have a history of migraines or other vestibular (inner ear) disorders, such as Meniere's disease.

What are the causes?

Vestibular System Disruption: The vestibular system is responsible for maintaining balance and spatial orientation. It is located within the inner ear and provides information to the brain about the body's position and movement in space. Disembarkment Syndrome may arise when there is a disruption or mismatch in the signals sent from the vestibular system to the brain. This can occur after prolonged exposure to motion, causing the brain to take longer to adapt to stable conditions.

Neuroplasticity and Neural Adaptation: Some researchers believe that Disembarkment Syndrome may be linked to neuroplasticity, which is the brain's ability to reorganise and adapt. After extended exposure to motion, the brain may undergo neural adaptations to the constant signals from the vestibular system. When the person disembarks, the brain struggles to revert to its original state, leading to the persistent illusion of motion.

Underlying Medical Conditions: Disembarkment Syndrome can sometimes be associated with other medical conditions, such as migraines, inner ear disorders (for example Meniere's disease) or neurological disorders. These underlying conditions may exacerbate the symptoms or act as triggers for the onset of Disembarkment Syndrome.

Environmental Factors: Prolonged exposure to certain environments, such as cruise ships, flights or virtual reality simulations, has been identified as potential triggers for Disembarkment Syndrome. The continuous motion experienced in such environments may influence the brain's perception of motion even after leaving the setting.

What are the symptoms?

Rocking Sensation: A hallmark of Disembarkment Syndrome is the perception of rocking or swaying, as if standing on the deck of a moving ship. This sensation can persist throughout the day and worsen with specific triggers, such as being in crowded places or under stress.

Floating Sensation: Individuals with Disembarkment Syndrome may describe feeling like they are floating or bobbing, even when they are seated or lying down. This sensation can create a disconnect between their perceived body position and the actual physical environment.

Balance and Coordination Issues: Disembarkment Syndrome can lead to difficulties with balance and coordination, making it challenging for affected individuals to walk steadily or perform daily activities without feeling unsteady or off-balance.

Headaches and Dizziness: Many people with Disembarkment Syndrome report experiencing persistent headaches and dizziness, often associated with the unending sensation of motion.

Fatigue and Cognitive Impairment: The constant struggle to adapt to the perceived motion can result in mental fatigue and difficulties with concentration and memory. Tasks that were once effortless may become arduous for those grappling with this condition.

Sensory Sensitivities: Some individuals may develop heightened sensitivity to visual stimuli, such as moving patterns, flashing lights or busy environments. This sensitivity can exacerbate their symptoms and contribute to feelings of discomfort and disorientation.

How is it diagnosed?

Diagnosing MdDS can be challenging due to its rarity and the overlap of symptoms with other conditions. There is no single definitive test for MdDS and the diagnosis is usually made based on clinical evaluation, patient history and exclusion of other potential causes.

How is it treated?

Vestibular Rehabilitation Therapy (VRT): VRT is a type of physical therapy that focuses on retraining the vestibular system to improve balance and reduce symptoms of dizziness and unsteadiness. A trained vestibular therapist can design a personalised exercise programme to help the brain adapt to the sensations of motion.

Medications: Certain medications may be prescribed to help alleviate specific symptoms of Disembarkment Syndrome. These may include anti-dizziness drugs or medications to manage associated symptoms like headaches or anxiety.

Ginger and peppermint: Some individuals have reported finding relief from motion-related symptoms by using ginger and peppermint, which are known for their potential anti-nausea properties. These can be taken as supplements, in teas or as aromatherapy.

Vitamin B12 and Magnesium: Adequate levels of vitamin B12 and magnesium are essential for overall health and may play a role in supporting the nervous system.

Transcranial Magnetic Stimulation (TMS): Some studies have explored the use of repetitive transcranial magnetic stimulation to modulate brain activity and potentially reduce symptoms in individuals with MdDS. However, more research is needed to establish the effectiveness of TMS for this condition.

Relaxation techniques and stress management: Stress and anxiety can exacerbate symptoms of MdDS. Learning relaxation techniques and stress management strategies, such as meditation, deep breathing exercises, and counselling, may be beneficial in coping with the condition.

Acupuncture: Acupuncture, a traditional Chinese therapy involving the insertion of thin needles into specific points on the body, has been explored by some individuals with MdDS to manage symptoms.

Lifestyle modifications: Avoiding triggers that worsen symptoms, such as prolonged exposure to motion or certain sensory stimuli, can be helpful. Adjusting daily routines and environments to minimise the impact of MdDS can contribute to a better quality of life.

Hydration and diet: Staying well-hydrated and maintaining a balanced diet can contribute to overall health and well-being. Reducing caffeine and alcohol intake may also be helpful for some individuals.

Renald Blundell is a biochemist and biotechnologist with a special interest in Natural and Alternative Medicine. He is a professor at the Faculty of Medicine and Surgery, University of Malta.

Andrea Weronika Gieleta is a registered nurse and is currently a medical student at the University of Malta