Mal de debarquement syndrome (MdDS) is a balance disorder in which patients develop a persistent internal sense of movement after a prolonged period of passive motion exposure. This is classically described as """"""""landsickness"""""""" occurring after boat rides. Patients describe a hallucination of movement such as """"""""rocking"""""""" and """"""""bobbing"""""""" even though they are not physically moving. This disorder is thought to be due to a primary problem of brain adaptation as testing of inner ear function and structural brain imaging is always normal. However, it is unknown which parts of the brain control this adaptation. Most cases of mal de debarquement only last a few hours, but there are many people who experience the symptoms for months or years, leading to significant morbidity. The term MdDS is generally reserved for patients who experience symptoms for at least one month. A large case series of patients with MdDS showed that the majority of these patients develop profound sensitivity to visual motion, a symptom which only occurs during their MdDS attacks and may be a key component of this syndrome. Therefore, investigating brain areas that respond to both visual and vestibular stimuli may reveal differences between patients with MdDS and normal controls. If there are differences in such areas, the activity may be modulated externally with repetitive transcranial magnetic stimulation (rTMS). Though still in the experimental phases, rTMS has been used in the treatment of many disorders characterized by maladaptive responses, most notably major depression, chronic pain, and tinnitus. Studies on tinnitus show that there is an area of heightened baseline activity in the auditory cortex and that this activity can be dampened with rTMS. The proposed studies in this grant will first assess differences in the ability to detect visual motion in a computer based motion detection task. The threshold values determined on this task will be used as stimulation parameters in an fMRI paradigm which seeks to activate brain areas that detect visual motion. The main area that will be activated is motion sensitive area MT+/V5 which receives both visual and vestibular information. MT+/V5 will serve as a target in a sham-controlled 1Hz rTMS treatment design. We hope to reveal functional differences in brain activity in MdDS and to be able to introduce a new modality of treatment for this currently incurable disorder.

Public Health Relevance

Mal de Debarquement Syndrome (MdDS) is an under-recognized disorder of balance control occurring after passive motion exposure such as on cruises, airplane or long car rides. It leads to significant morbidity and remains without a cure or knowledge about basic pathophysiology. Because the disorder is one of a phantom perception of self-motion and there is clinical evidence that visual motion processing may be affected, we hypothesize that brain areas that process both visual and vestibular information may be affected. If differences in the performance of psychophysical tasks that assess visual motion perception and in brain activation patterns in functional neuroimaging can be seen, then areas of differential activation may be targets for therapy with transcranial magnetic stimulation (TMS). The application of TMS to MdDS is proposed as a novel therapy for this disorder following the same rationale as other disorders of maladaptive cortical reorganization.

Agency
National Institute of Health (NIH)
Institute
National Institute on Deafness and Other Communication Disorders (NIDCD)
Type
Small Research Grants (R03)
Project #
7R03DC010451-04
Application #
8570074
Study Section
Special Emphasis Panel (ZDC1-SRB-Y (59))
Program Officer
Sklare, Dan
Project Start
2010-03-01
Project End
2014-02-28
Budget Start
2012-08-16
Budget End
2014-02-28
Support Year
4
Fiscal Year
2012
Total Cost
$149,072
Indirect Cost
$52,272
Name
Laureate Institute for Brain Research
Department
Type
DUNS #
967230579
City
Tulsa
State
OK
Country
United States
Zip Code
74136
Cha, Yoon-Hee; Deblieck, Choi; Wu, Allan D (2016) Double-Blind Sham-Controlled Crossover Trial of Repetitive Transcranial Magnetic Stimulation for Mal de Debarquement Syndrome. Otol Neurotol 37:805-12
Cha, Yoon-Hee (2015) Mal de debarquement syndrome: new insights. Ann N Y Acad Sci 1343:63-8
Ding, Lei; Shou, Guofa; Yuan, Han et al. (2014) Lasting modulation effects of rTMS on neural activity and connectivity as revealed by resting-state EEG. IEEE Trans Biomed Eng 61:2070-80
Guofa Shou; Han Yuan; Urbano, Diamond et al. (2014) Changes of symptom and EEG in mal de debarquement syndrome patients after repetitive transcranial magnetic stimulation over bilateral prefrontal cortex: a pilot study. Conf Proc IEEE Eng Med Biol Soc 2014:4294-7
Cha, Yoon-Hee; Cui, Yongyan (2013) Rocking dizziness and headache: a two-way street. Cephalalgia 33:1160-9
Cha, Yoon-Hee; Cui, Yongyan; Baloh, Robert W (2013) Repetitive transcranial magnetic stimulation for mal de debarquement syndrome. Otol Neurotol 34:175-9
Cha, Yoon-Hee K; Jog, Mayank A; Kim, Yoon-Chung et al. (2013) Regional correlation between resting state FDG PET and pCASL perfusion MRI. J Cereb Blood Flow Metab 33:1909-14
Cha, Yoon-Hee; Chakrapani, Shruthi; Craig, Alexis et al. (2012) Metabolic and functional connectivity changes in mal de debarquement syndrome. PLoS One 7:e49560