Treatment of Mal de Debarquement Syndrome (MdDS) by habituation of Velocity Storage.

通过适应 Velocity Storage 治疗 Mal de Barquement Syndrome (MdDS)。

• 批准号: 10054958
• 负责人: SERGEI YAKUSHIN
• 金额: $ 21.19万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10054958
• 关键词: Aftercare; Animals; Anxiety; Brain; Coupled; Crowding; Data; Disease; Dizziness; Effectiveness; Esthesia; Exposure to; Fatigue; Feeling suicidal; Financial compensation; Fogs; Functional disorder; Goals; Gravitation; Head; Headache; Home; Hypersensitivity; Impaired cognition; Impairment; Laboratories; Light; Measures; Mental Depression; Mental Health; Methods; Migraine; Motion; Motion Sickness; Names; Nervous System Physiology; Noise; Outcome; Patients; Peripheral; Posture; Predisposition; Protocols documentation; Randomized; Recurrence; Reporting; Research; Severities; Short-Term Memory; Specific qualifier value; Speech; Standardization; Symptoms; Syndrome; Testing; Transportation; Travel; Treatment Effectiveness; Treatment Protocols; Visual; Visual Fields; Visual Motion; Walking; base; common symptom; effective therapy; equilibration disorder; experimental study; follow-up; habituation; improved; motion sensitivity; pressure; reduce symptoms; relating to nervous system; success; symptomatic improvement; vestibulo-ocular reflex

Abstract: Mal de Debarquement Syndrome (MdDS) is an under-recognized but nevertheless common balance disorder, primarily manifested by constant self-motion sensations consisting of rocking/swaying or gravitational pull of the body, which are accompanied by fatigue, migraine, hypersensitivity to light/noise/crowds, visually induced dizziness, and cognitive dysfunctions. As the name implies (“disembarkation sickness”), in most cases MdDS occurs after exposure to prolonged passive motion, specified as motion-triggered (MT) MdDS. However, the symptoms of MdDS can also occur without a motion trigger, termed as spontaneous MdDS. MdDS is debilitating and entails various mental health issues, such as suicidal thoughts, depression, and anxiety. Treatments for this disorder are still limited, as the specific underlying pathophysiology remains unclear. Recently, our team developed the first treatment method that can safely and effectively ease MdDS symptoms in the majority of patients via readaptation of the vestibulo-ocular reflex (VOR). The hypothesis underlying this treatment is that MdDS is caused by maladaptation of the functional component of the VOR called velocity storage, whose readaptation can be stimulated by exposure to whole-field visual motion coupled with head tilts. Over the past several years, more than 500 patients from around the world have been treated with this method. The success rate immediately after this treatment is 75% for MT MdDS, but some patients report return of symptoms after subsequent flights or prolonged car rides. Thus, the effectiveness of the current MdDS treatment protocol can depend on a serious practical limitation of needing to permanently avoid transportation. Building on the previous hypothesis of velocity storage maladaptation, we currently hypothesize that another method, based on the reduction (habituation) of the velocity storage, can also resolve MdDS symptoms. Velocity storage can be greatly habituated within 4-5 days using a protocol previously developed in our laboratory to reduce susceptibility to motion sickness. Preliminary data support the application of this protocol to MdDS. Moreover, since animal-based research suggests that velocity storage habituation is permanently retained, we further hypothesize that this new treatment method yields robust long-term outcomes. In this project, 30 MT MdDS patients with otherwise normal vestibular and neurological functions will be randomly assigned into two groups, one to be treated by velocity storage habituation and the other by readaptation. Patients will be followed up for 6 months. Based on the preliminary data, we expect both groups to yield similar initial success rates for symptom improvement. However, we expect the group undergoing the habituation protocol to better retain the initial treatment impact in the long term. This project will significantly impact the MdDS treatment practice. The current approach focuses on reducing symptoms, but they can be retriggered by another prolonged exposure to passive motion. The habituation approach on the other hand focuses on permanently minimizing the symptom trigger while also minimizing symptoms. This project will also increase the current understanding of recurrent MdDS.

摘要：精神错乱综合症（MdDS）是一种未被充分认识但却很常见的平衡 紊乱，主要表现为持续的自我运动感觉，包括摇摆/摇摆或重力 身体的拉动，伴随着疲劳，偏头痛，对光/噪音/人群过敏，视觉 导致头晕和认知功能障碍顾名思义（“下船病”），在大多数情况下， MdDS发生在暴露于长时间被动运动后，称为运动触发（MT）MdDS。然而，在这方面， MdDS的症状也可以在没有运动触发的情况下发生，称为自发性MdDS。MDDS是 使人衰弱，并引起各种心理健康问题，如自杀念头、抑郁和焦虑。 这种疾病的治疗仍然是有限的，因为具体的基础病理生理学仍然不清楚。 最近，我们的团队开发了第一种可以安全有效缓解MdDS症状的治疗方法 在大多数患者中通过前庭眼反射（VOR）的再适应。这背后的假设是 一种治疗方法是，MdDS是由VOR的功能成分（称为速度）的适应不良引起的 存储，其再适应可以通过暴露于与头部倾斜相耦合的全场视觉运动来刺激。 在过去的几年里，来自世界各地的500多名患者用这种方法治疗。 MT MdDS治疗后即刻的成功率为75%，但一些患者报告称， 后续航班或长时间乘车后出现症状。因此，目前MDDS治疗的有效性 协议可以依赖于需要永久避免运输的严重实际限制。基础上 以前的假设速度存储适应不良，我们目前假设，另一种方法，基于 在减少（习惯化）的速度存储，也可以解决MdDS症状。Velocity存储罐 在4-5天内使用我们实验室先前开发的方案大大习惯于减少 易患晕动病。初步数据支持将该方案应用于MdDS。此外，委员会认为， 由于基于动物的研究表明，速度储存习惯是永久保留的，我们进一步 假设这种新的治疗方法产生了强大的长期结果。在该项目中，30 MT MdDS 将前庭和神经功能正常的患者随机分为两组， 一个通过速度存储习惯化处理，另一个通过再适应处理。将对患者进行随访， 6个月根据初步数据，我们预计两组在症状缓解方面的初始成功率相似。 改进.然而，我们希望接受习惯化方案的小组能更好地保留最初的习惯。 长期的治疗效果。该项目将对MDDS治疗实践产生重大影响。当前 这种方法的重点是减少症状，但它们可能会被另一种长时间的被动暴露所触发。 议案另一方面，习惯化方法侧重于永久性地减少症状触发 同时还能减轻症状该项目还将增加目前对经常性的千年发展目标的了解。