Developing robust treatment options for Mal de Débarquement Syndrome

摘要：Mal de Débarquement综合征（MdDS）是一种未被充分认识但却很常见的疾病 平衡障碍，这在大多数情况下发生在暴露于长时间的被动运动之后。MdDS，慢性 这种疾病可以持续多年，表现为持续的摇摆/摇摆的虚假感觉， 引力MDDS是衰弱的，因为这些症状和体征通常伴随着其他症状和体征。 可能是继发性的身体认知和情感问题除了运动触发（MT）病例外， 相同或难以区分的症状可以在没有特定触发因素的情况下发生，被识别为自发性发作 (SO)MDDS。MdDS的治疗选择是有限的，直到最近才取得突破， 我们的临床实验室与生理再适应前庭眼反射（VOR）。此前提 治疗的方法是MdDS是由VOR的一种功能成分（称为速度储存）的适应不良引起的， 它塑造了空间方向和自我运动的感知。治疗由以下人员实施： 在全视野视动刺激期间操纵坐在圆柱形腔室内的患者的头部 （OKS）。我们目前治疗MT和SO MdDS后即刻的成功率分别为75%和50%， 分别一项后续研究表明，成功率后来波动，以及相当多的 的患者仍然对明亮的灯光，视觉物体的运动和运输敏感，指出 治疗方法的局限性。一个主要障碍是获得治疗。全域OKS需要一个专门的 在一个专门的房间里设置，使治疗只能在世界各地的几个实验室。我们 最近成功地试点测试了虚拟现实（VR）护目镜治疗MdDS的功效， 再适应方法。在这个拟议的项目中，VR护目镜将在更大的患者群体中进行测试， 将效果与全场OKS的效果进行比较。如果被证明是有效的，MdDS可以在当地治疗， 患者在许多前庭治疗办公室，不仅为初步治疗，而且为补救或后续行动 症状复发时进行治疗。该建议还解决了VOR重新调整的弱点 通过测试补充方法。我们假设，减少（习惯）速度存储 能力降低对身体运动的敏感性，改善MdDS症状并限制症状 复发我们进一步假设对视觉刺激的脱敏可以减少视觉诱发的头晕 在MdDS患者中常见。我们将验证这些补充治疗是否能提供 与再适应治疗本身相比，结果更好。最后，我们假设没有头部的OKS 运动可以减少MdDS患者通常报告的重力牵引的假感觉。两个一百 该研究将招募MdDS患者。患者将每天治疗1 - 2小时，持续5天。患者将 最长可随访12个月。拟议的研究将通过以下方式促进改善MDDS的结局： 扩大治疗选择。

ABSTRACT: Mal de Débarquement Syndrome (MdDS) is an under-recognized but nevertheless common balance disorder, which in most cases occurs after exposure to prolonged passive motion. MdDS, a chronic illness that can last for many years, is manifested by persistent false sensations of rocking/swaying or gravitational pull. MdDS is debilitating as these symptoms and signs are typically accompanied by other presumably secondary physical, cognitive, and affective problems. In addition to motion-triggered (MT) cases, the same or indistinguishable symptoms can occur without a specific trigger, identified as spontaneous-onset (SO) MdDS. Treatment options for MdDS are limited, and it was only recently that a breakthrough was made in our clinical laboratory with physiological readaptation of the vestibulo-ocular reflex (VOR). The premise of this treatment is that MdDS is caused by maladaptation of a functional component of the VOR called velocity storage, which shapes spatial orientation and the perception of self-motion. The treatment has been administered by maneuvering the head of the patient seated inside a cylindrical chamber during a full-field optokinetic stimulation (OKS). Our current success rates immediately after treatment of MT and SO MdDS are 75% and 50%, respectively. A follow-up study indicated that the success rates later fluctuate as well as that a significant number of patients remain sensitive to bright lights, movements of visual objects, and transportation, pointing to the treatment method's limitations. A primary hurdle is access to the treatment. Full-field OKS requires a specialized set-up in a dedicated room, making the treatment possible only in several laboratories around the world. We recently successfully pilot tested the efficacy of virtual reality (VR) goggles for MdDS treatment with the readaptation approach. In this proposed project, VR goggles will be tested on a larger group of patients, and the effects will be compared to those of full-field OKS. If proven to be effective, MdDS can be treated locally to patients in many vestibular therapy offices, not only for initial treatment but also for remedial or follow-up treatment when symptoms return. This proposal also addresses the weaknesses of the VOR readaptation approach by testing complementary approaches. We hypothesize that reducing (habituating) the velocity storage capacity decreases sensitivity to physical movement and improves MdDS symptoms as well as limits symptom recurrence. We further hypothesize that desensitization to visual stimuli can reduce visually induced dizziness frequently observed in patients with MdDS. We will verify whether these complementary treatments will provide a better outcome compared to the readaptation treatment by itself. Lastly, we hypothesize that OKS without head motion can reduce the false sensation of gravitational pull commonly reported by MdDS patients. Two hundred MdDS patients will be recruited for the study. Patients will be treated for 1-2 hours a day for 5 days. Patients will be followed up with for up to 12 months. The proposed study will facilitate improved outcomes for MdDS by broadening its treatment options.