Mal de Debarquement Sendromu ve Kanıta Dayalı Tedavi Yaklaşımları

Abstract

Mal de debarquement kelimesinin tam karşılığı karaya çıkma hastalığıdır. Bu terim başlangıçta su üzerinde gemi veya tekne ile yapılan seyahatin bir yan etkisi olarak hissedilen hareket yanılsaması şeklinde belirtilse de günümüzde uçak, otomobil, tren gibi ulaşım araçlarından sonra da görülebildiği bildirilmiştir. Çoğu denizcinin yaşadığı bu durum genellikle 24 saat içerisinde düzelir. Bununla birlikte, MdDS’de bu hareket yanılsaması haftalar, aylar, hatta yıllar boyunca devam eder. Sıklıkla kadın cinsiyette görülen bu sendroma sahip bireyler üzerinde yapılan nörogörüntüleme çalışmalarında bireylerin beyin metabolizmasında ve fonksiyonel beyin bağlantılarında değişiklikler meydana gelmiştir bu da sorunun iç kulakta değil beyinde olduğunu göstermektedir. Bu değişiklikler sonucunda beyin alışılmadık bir harekete uyum sağlayabilir ancak hareket durduktan sonra yeni duruma uyum gösteremez. Bunun sonucunda da sallantı hissiyle gelen baş dönmesi, denge kaybı, yorgunluk, ışığa karşı hassasiyet, anksiyete ve depresyon gibi semptomlar meydana gelebilir. Sendromun tanısı için özel bir test bulunmadığından hastanın hikayesi çok önemlidir. Semptomların diğer nedenlerini dışlamak için de vestibüler testler ve radyolojik görüntüleme yöntemleri kullanılmaktadır. Mal de debarquement sendromunun tedavisinde güçlü bir etkiye sahip tek bir yaklaşım bulunmamaktadır. Standart olarak reçete edilen bazı ilaçların semptomları azaltmada zayıf bir etkiye sahip olduğu belirtilmektedir. Küçük örneklem boyutlarıyla yapılan ancak umut vadeden bazı tedavi yöntemleri arasında, vestibüler rehabilitasyon, optokinetik stimülasyon, benzodiazepin kullanımı, tekrarlı transkraniyal manyetik stimülasyon gibi nöromodülasyon yöntemlerinin kullanımı yer almaktadır. Bu derlemenin amacı mal de debarquement sendromunu, sendromun oluşum mekanizmasını ve kanıta dayalı güncel tedavi yaklaşımlarını incelemektir.

Keywords

• fizyoterapi ve rehabilitasyon
• mal de debarquement sendromu
• MdDS
• vestibüler bozukluk

Mal de Debarquement Syndrome and Evidence-Based Treatment Approaches

Abstract

The aim of the descriptive study is to determine the factors affecting the postoperative sleep quality and Mal de debarquement is a sickness of disembarkation in which habituation to background rhythmic motion becomes resistant to readjustment to stable conditions, resulting in an illusory perception of self-movement typically described as rocking, bobbing, and swaying. It is commonly seen in the female gender. This condition, experienced by most sailors, usually resolves within 24 hours. However, in some people, this illusion of movement persists for weeks, months, or even years. Neuroimaging studies on individuals with this syndrome have seen changes in brain metabolism and functional brain connections, suggesting that the problem is in the brain, not the inner ear. As a result of these changes in the brain, the brain can adapt to an unusual move, but after the movement stops, the individual cannot adapt to the new situation. The history of the patient is very important as there is no specific test for the diagnosis of the disease. Vestibular tests and radiological imaging methods are used to exclude other causes of symptoms. There is no single highly effective approach to the treatment of the disease. Some drugs prescribed as standard are noted to have a weak effect in reducing symptoms. Some promising treatment methods with small sample sizes include the use of neuromodulation methods such as vestibular rehabilitation, optokinetic stimulation, use of benzodiazepines, and repetitive transcranial magnetic stimulation. The aim of this study is to review mal debarquement syndrome, its causes, and current evidence-based treatment approaches.

Keywords

• physiotherapy and rehabilitation
• mal de debarquement syndrome
• MdDS
• Vestibular disorder

References

1. Buard, I, Lopez-Esquibel, N, Schoeneberger, S, Berliner, J.M, Kluger, B.M, Transcranial Magnetic Stimulation as Treatment for Mal de Debarquement Syndrome: Case Report and Literature Review, Cognitive Behavioural Neurology, 2020,33(2),145–53.
2. Canceri, J.M, Brown, R, Watson, S.R, Browne, C.J, Examination of current treatments and symptom management strategies used by patients with Mal de Debarquement syndrome, Frontiers in Neurology, 2018, 9(943), 1–13.
3. Mucci, V, Canceri, J.M, Brown, R, Dai, M, Yakushin, S, Watson, S, et al. Mal de Debarquement Syndrome: a survey on subtypes, misdiagnoses, onset and associated psychological features, Journal of Neurology, 2018, 265(3), 486–99.
4. Van Ombergen, A, Rompaey, V.V, Maes, L.K, Van De Heyning, P.H, Wuyts F.L, Mal de debarquement syndrome: a systematic review, Journal of Neurology, 2016, 263, 843–54.
5. Brown, J.J, Baloh, R.W, Persistent mal de debarquement syndrome: A motion-induced subjective disorder of balance, American Journal of Otolaryngology, 1987, 8(4), 219–22.
6. Cha, Y.H. Mal de debarquement syndrome: new insights. Annals of the New York Academy of Sciences, 2015, 1343(1), 63–8.
7. Ghavami, Y, Ziai, K.N, Haidar, Y.M, Moshtaghi, O, Bhatt, J, Lin, H.W, et al. Management of Mal de Debarquement Syndrome as Vestibular Migraines. Laryngoscope, 2017, 127(7), 1670–5.
8. Cha, Y.H, Mal de debarquement. Seminars in Neurology, 2009, 29(5), 520–7.

9. Macke, A, LePorte, A, Clark, B.C, Social, societal, and economic burden of mal de debarquement syndrome, Jounal of Neurology, 2012, 259(7), 1326–30.
10. Hain, T.C, Cherchi, M, Mal de débarquement syndrome. In: Furman JM, Lempert T, editors. Handb. Clin. Neurol., vol. 137. 3rd series, Chicago, IL, USA: Elsevier B.V.; 2016, p. 391–5. https://doi.org/10.1016/B978-0-444-63437-5.00028-5.
11. Cha, Y.H, Chakrapani, S, Craig, A, Baloh, R.W, Metabolic and Functional Connectivity Changes in Mal de Debarquement Syndrome, PLoS One, 2012, 7(11), e49560.
12. Cha, Y.H, Chakrapani, S, Voxel Based Morphometry Alterations in Mal de Debarquement Syndrome, PLoS One, 2015, 10(8), e0135021.
13. Cha, Y.H, Baloh, R, Cho, C, Magnusson, M, Song, J.J, Strupp, M, et al., Mal de débarquement syndrome diagnostic criteria: Consensus document of the Classification Committee of the Bárány Society, Journal of Vestibular Research, 2020, 30(5), 285–93.
14. Hain, T.C, Hanna, P.A, Rheinberger, M.A, Mal de Debarquement, Archives of Otolaryngoly Head Neck Surgery, 1999, 125(6), 615–20.
15. Cha, Y.H, Brodsy J, Ishiyama, G, Sabatti, C, Baloh, R.W, Clinical features and associated syndromes of mal de debarquement, Journal of Neurology, 2008,255(7),1038–44. https://doi.org/10.1007/s00415-008-0837-3.
16. Cha YH, Cui Y, Baloh RW. Repetitive transcranial magnetic stimulation for Mal de Debarquement Syndrome. Otology & Neurotology, 2013, 34(1), 175–9. https://doi.org/10.1097/MAO.0b013e318278bf7c.
17. Ding, L, Shou, G, Yuan, H, Urbano, D, Cha, Y-H. Lasting Modulation Effects of rTMS on Neural Activity and Connectivity as Revealed by Resting-State EEG HHS Public Access. IEEE Transactions on Biomedical Engineering, 2014, 61(7), 2070–80.
18. Pearce, A.J, Davies, C.P, Major, B.P, Efficacy of neurostimulation to treat symptoms of Mal de Debarquement Syndrome, A preliminary study using repetitive transcranial magnetic stimulation, Journal of Neuropsychology, 2015, 9(2), 336–41.
19. Dai, M, Cohen, B, Smouha, E, Cho, C, Readaptation of the vestibulo-ocular reflex relieves the mal de debarquement syndrome, Frontiers in Neurology, 2014, 5(124), 1–6.
20. Dai, M, Cohen, B, Cho, C, Shin, S, Yakushin, S.B. Treatment of the Mal de Debarquement syndrome: a 1-Year Follow-up. Frontiers in Neurology, 2017, 8(175), 1-10.
21. Mucci, V, Perkisas, T, Jillings, S.D, Van Rompaey, V, Van Ombergen, A, Fransen, E, et al., Sham-Controlled Study of Optokinetic Stimuli as Treatment for Mal de Debarquement Syndrome, Frontiers in Neurology, 2018, 9(887), 1-13.
22. Hoppes, C.W, Vernon, M, Morrell, R.L, Whitney S.L, Treatment of Mal de Debarquement Syndrome in a Computer-Assisted Rehabilitation Environment, Miltary medicine, 2022, 187(7-9), e1011-1015.
23. Cha, Y.H, Deblieck,, C, Wu, A, Double-blind sham-controlled cross-over trial of repetitive transcranial magnetic stimulation for Mal de Debarquement Syndrome, Otology & Neurotology, 2016, 37(6), 805–12.
24. Schenk, S.M, Wagner, J.M, Miller, J.A, Lyons-White, T.M, Venn, E.C, April, M.D, et al., Treatment of Mal de Debarquement Syndrome in a Deployed Environment, Military Medicine, 2018, 183(11-12), e775–8.
25. Cha, Y.H, Gleghorn, D, Doudican, B, Occipital and Cerebellar Theta Burst Stimulation for Mal De Debarquement Syndrome, Otology & Neurotology, 2019, 40(9), e928–37.