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：Mal de Debarquement Syndrome (MdDS) 是一种未被充分认识但仍然常见的平衡问题 障碍，主要表现为持续的自我运动感觉，包括摇摆/摇摆或重力 身体拉力，伴有疲劳、偏头痛、对光/噪音/人群过敏、视觉 诱发头晕、认知功能障碍。顾名思义（“下船病”），在大多数情况下 MdDS 在暴露于长时间被动运动后发生，称为运动触发 (MT) MdDS。然而， MdDS 的症状也可能在没有运动触发的情况下出现，称为自发性 MdDS。 MdDS 是 使人衰弱，并引发各种心理健康问题，例如自杀念头、抑郁和焦虑。 这种疾病的治疗方法仍然有限，因为具体的潜在病理生理学仍不清楚。 近期，我们团队研发出首个可以安全有效缓解MdDS症状的治疗方法 大多数患者通过前庭眼反射（VOR）的重新适应。这背后的假设 治疗方法是 MdDS 是由称为速度的 VOR 功能组件适应不良引起的 存储，其重新适应可以通过暴露于全场视觉运动加上头部倾斜来刺激。 在过去的几年里，来自世界各地的500多名患者接受了这种方法的治疗。 MT MdDS 治疗后立即成功率为 75%，但有些患者报告恢复 后续飞行或长时间乘车后出现的症状。因此，目前 MdDS 治疗的有效性 协议可能取决于需要永久避免运输的严重实际限制。建立在 先前关于速度存储适应不良的假设，我们目前假设另一种方法，基于 减少（习惯）储存速度，也可以解决 MdDS 症状。速度存储可以 使用我们实验室先前开发的方案在 4-5 天内即可完全习惯，以减少 容易晕车。初步数据支持该协议在 MdDS 中的应用。而且， 由于基于动物的研究表明速度存储习惯会永久保留，我们进一步 假设这种新的治疗方法会产生稳健的长期结果。在这个项目中，30 MT MdDS 前庭和神经功能正常的患者将被随机分为两组， 一个通过速度存储习惯来治疗，另一个通过重新适应来治疗。患者将接受随访 6个月。根据初步数据，我们预计两组症状的初始成功率相似 改进。然而，我们期望接受习惯化协议的小组能够更好地保留最初的状态 治疗的长期影响。该项目将对 MdDS 治疗实践产生重大影响。目前的 该方法的重点是减轻症状，但长期暴露于被动环境可能会重新引发症状 运动。另一方面，习惯化方法侧重于永久最小化症状触发因素 同时还能最大限度地减少症状。该项目还将增加目前对复发性 MdDS 的理解。