Developing robust treatment options for Mal de Débarquement Syndrome

开发针对 Mal de Débarquement 综合征的稳健治疗方案

• 批准号: 10531023
• 负责人: SERGEI YAKUSHIN
• 金额: $ 52.72万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10531023
• 关键词: Address; Affective; Aftercare; Back; Chronic; Chronic Disease; Clinical; Cognitive; Complementary therapies; Controlled Study; Coupled; Custom; Data; Devices; Disease; Dizziness; Esthesia; Exposure to; Follow-Up Studies; Force of Gravity; Foundations; Frequencies; Gravitation; Head; Health Services Accessibility; Home; Hour; Improve Access; Intervention; Laboratories; Methods; Motion; Motion Sickness; Movement; New York City; Outcome; Patients; Physiological; Placebos; Predisposition; Protocols documentation; Randomized; Recurrence; Reporting; Self Perception; Shapes; Ships; Side; Signs and Symptoms; Space Perception; Symptoms; Syndrome; Telemedicine; Testing; Torsion; Transportation; Travel; Treatment Effectiveness; Treatment Protocols; Treatment outcome; Vision; Visual; Visual Fields; Visual Motion; base; clinical practice; cost; desensitization; design; efficacy evaluation; efficacy testing; equilibration disorder; experience; follow-up; habituation; improved; improved outcome; motion sensitivity; patient screening; pilot test; portability; recruit; reduce symptoms; success; symptomatic improvement; symptomatology; vestibulo-ocular reflex; virtual reality; virtual reality headset; visual stimulus

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.

摘要：Mal de Débarquement综合征(MdDS)是一种认识不足但仍很常见的疾病 平衡障碍，大多数情况下发生在长时间的被动运动之后。患有慢性病的MDDS 可能会持续多年的疾病，表现为持续的摇摆/摇摆或 万有引力。MDDS使人虚弱，因为这些症状和体征通常伴随着 可能是继发性的身体、认知和情感问题。除了运动触发(MT)情况外， 相同或难以区分的症状可在没有特定触发因素的情况下发生，称为自发性 (所以)MDDS。治疗MDDS的选择是有限的，直到最近才在 我们的临床实验室对前庭-眼反射(VOR)进行生理性再适应。这样做的前提是 治疗方法是MDDS是由称为速度存储的VOR的功能组件的不适应引起的， 它塑造了空间方向和自我运动的感知。这种治疗已经由 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 (好的)。我们目前治疗MT和So MDDS的成功率分别为75%和50%， 分别进行了分析。一项后续研究表明，后来的成功率波动很大，而且有相当一部分 的患者对明亮的光线、视觉物体的移动和运输仍然敏感，指出 治疗方法的局限性。一个主要障碍是获得治疗的机会。全场OKS需要专门的 在一个专用的房间里设置，使治疗只可能在世界各地的几个实验室。我们 最近成功地试行了虚拟现实(VR)护目镜治疗MdDS的有效性 再适应方法。在这个拟议的项目中，VR护目镜将在更多的患者身上进行测试， 效果将与全场OKS的效果进行比较。如果证明是有效的，MDDS可以在当地治疗 许多前庭治疗办公室的患者，不仅是为了最初的治疗，也是为了补救或后续 当症状再次出现时进行治疗。这项建议还解决了VOR重新适应的弱点 通过测试互补的方法来实现。我们假设减少(习惯)速度存储 容量降低对身体运动的敏感度，改善MdDS症状以及限制症状 复发。我们进一步假设，对视觉刺激的脱敏可以减少视觉诱导的头晕 常见于MDDS患者。我们将验证这些补充治疗是否会提供 与重新适应治疗本身相比，这是一个更好的结果。最后，我们假设没有头部的OKs 运动可以减少MDDS患者常见的重力拉力假感。两百 这项研究将招募MDDS患者。患者将接受为期5天的每天1-2小时的治疗。患者会 接受长达12个月的随访。拟议的研究将通过以下方式促进改善MDDS的结果 拓宽其治疗选择。