Mucci, V., Perkisas, T., Jillings, S.D., Van Rompaey, V., Van
Introduction: Mal de Debarquement Syndrome (MdDS) is a condition characterized by a perception of self-motion in the absence of a stimulus, with two onset types: Motion-Triggered and Spontaneous. Currently, the pathophysiology is unknown and consequently, the therapeutic options are limited. One proposed treatment protocol, developed by Dai and colleagues is based on optokinetic stimulation, which aims to re-adapt the vestibular ocular reflex. This study aimed to reproduce the treatment protocol developed by Dai and colleagues and to assess if a placebo effect is present in the treatment protocol and lastly, aimed to further investigate the treatment on MdDS patient outcomes.
Method: Twenty-five MdDS patients (13 Motion-Triggered and 12 Spontaneous) were exposed to 5 consecutive days of optokinetic treatment (consisting of exposure to optokinetic stimuli with head movements). Eleven of these 25 patients were also exposed to 2 days of a sham treatment prior to the OKN treatment. Posturography measurements and reported symptoms [e.g., using the visual analog scale (VAS)] of patients were assessed throughout the treatment. Posturography data of the patients was compared with the data of 20 healthy controls.
Results: No placebo effect was recorded with any changes in postural data and VAS scale. After the optokinetic treatment, a significant improvement in postural control was observed in 48% of patients, of whom 70% were of the Motion-Triggered subtype (p-values: Area under the Curve—Anterior Posterior < 0.001; Area under the Curve—Medio Lateral p < 0.001, Confidence Ellipse Area (CEA) < 0.001, Velocity < 0.001).
Conclusion: The protocol was effective in approximately half of the MdDS patients that took part in the study, with no placebo effect recorded. The Motion-Triggered group responded better to treatment than the Spontaneous group. In addition to this, this study indicates that the greatest postural changes occur within the first 3 days of treatment, suggesting that a shorter protocol is possible. Overall, these findings support what was previously observed in Dai’s studies, that optokinetic stimulation can reduce and ease self-motion perception in those with MdDS. Thus, validating the reproducibility of this protocol, suggesting that a consistent and uncomplicated implementation across treatment centers is possible.
IMAGINE LIVING LIFE WITHOUT BALANCE.
Close your eyes and stand on one foot. It’s hard right? Now imagine having that same disoriented feeling on two feet, and with your eyes open. Balance is something most of us take for granted. It’s automatically hardwired into our bodies at birth, evolving and adapting as we grow and age. While basic balance is innate, some of us are able to perfect or even master our balance through exercise and practice. We don’t often think about our balance—until of course, we lose it.
While most people may not be familiar with the word “vestibular”—relating to your inner ear, brain, and sense of balance—many of us have likely experienced the awkward or sometimes scary feeling when we momentarily lose our balance. Maybe it’s taking a wrong step or getting motion sickness aboard a jostling boat. Or that nauseating head-spinning sensation after one too many alcoholic beverages.
Eventually our balance comes back and life moves on.
This is not the case for the over 69 million Americans who suffer from the mostly invisible and frequently debilitating symptoms of chronic imbalance association with a vestibular disorder.
Whether it comes on gradually over time or all of the sudden, bouts of dizziness, vertigo, and nausea can make many of life’s more routine tasks virtually intolerable. Just try getting a good night’s sleep with a high-pitched ringing in your ear. Or try to focus on something as everything around you appear to be spinning.
For those living with a vestibular condition, everyday life becomes a progressively challenging obstacle course to navigate.
That is why VeDA pioneered Balance Awareness Week in 1997: to be an opportunity each year to come together and shine a light on these otherwise invisible balance disorders. If we’re all more aware, then we can better understand and be empathetic to those who need our support the most—our family, friends, co-workers, and neighbours. While many of these balance disorders are incurable, faster and more accurate diagnosis, along with effective coping strategies can greatly improve quality of life.
Join Balance Awareness Week, and together we can pave the way toward restoring a life rebalanced.
- Balance Awareness Week (BAW) is 9/16-9/22
- 30% of the U.S. population has transient or constant issues with balance
- The goal of BAW is to educate the public about vestibular disorders so people with undiagnosed dizziness and imbalance can get the help they need, reducing healthcare costs and improving quality of life.
The career journey so far… so many places, people, and learnings. We’ve been going through images from travels across the world, to celebrations of wonderful people met… and this is another flashback to Professor Nutti’s Retirement celebration in Sienna 2013…
This photo is of the Master Class for Vestibular Testing in Amsterdam (2016).
Their findings reveal a unique biological mechanism for maintaining fluid pressure and composition and may inform the study and treatment of disorders involving defects in inner ear pressure such as Meniere’s disease, a condition marked by vertigo, hearing loss and ringing in the ears. The results could also help researchers study pressure control in other organs such as the eyes and kidneys, which also have liquid-filled cavities.
Prof. Rask-Andersen is a specialist in ENT & Audiology, an anatomist, and electron microscopist, and he is a senior Professor in experimental Otology at the Uppsala University and the Academic Hospital in Uppsala, Sweden. He currently runs the Research Department at the Academic Hospital.
In this article, Prof. Rask-Andersen explains the intricate functions of the cochlea and why structure preservation should be a priority for every cochlear implant surgery—even if there is no residual hearing. He shows why damage to the delicate cochlear structures can have such an adverse effect on the health of the underlying neural structures, and the impact this can have on outcomes with a cochlear implant.
You are invited to participate in a research study being conducted by Dr. Cherylea Browne, Lecturer in Human Anatomy, School of Science & Health and Ms. Viviana Mucci, Doctoral Student, Antwerp University Research Centre for Equilibrium and Aerospace (AUREA) & Laboratory of BioMedical Physics (BIMEF), University of Antwerp.
This research aims to contribute to the understanding of the underlying mechanisms of Mal de Debarquement Syndrome (MdDS). Specifically, this study seeks to collate data regarding the effects of pregnancy on MdDS symptoms.
The study aims to collect survey data from MdDS patients who are currently pregnant or who were pregnant whilst having MdDS, so please tag or share with anyone who might be interested in taking part in their research.
Click here to complete the survey – uwsssap.co1.qualtrics.com/jfe/form/SV_cu811naTKs6CHd3
For any inquiries or more information, please contact Josephine (email@example.com) or Cherylea Browne (firstname.lastname@example.org) via email.
MdDS Research Group Facebook Page: facebook.com/MdDSResearchGroup/
Article on Whirled Foundation: whirledfoundation.org/mal-de-ebarquement-syndrome-mdds-research/
Quote: “Dr Cherylea Browne from the MdDS Research Group at Western Sydney University became interested in MdDS after her own diagnosis of the condition and is now conducting research into the clinical features of MdDS. Her interests include the underlying hormonal aspects of MdDS and autonomic nervous system maladaptation in MdDS patients. The MdDS Research Group, though early in its formation, has generated interest from around the world, with collaborators contributing to research studies from Mt Sinai Hospital in New York, Prince of Wales Hospital in Sydney and Antwerp University Hospital in Belgium.”
Professor Dr Margie Sharpe says, “loss of confidence after a fall all too often translates into avoidance of physical movement/activity. Meaning, we sit for long periods of time in an attempt to avoid falling over. Unfortunately, the lack of physical activity actually causes more falls.”
You can think of it along these lines; sitting is the killer and movement is the healer. To activate our balance mechanisms we need to move (eg walking on uneven surfaces, shopping, gardening).
We are designed to live in a gravitational world (not in outer space); so gravity is our friend and not our foe.
But what if we showed you how to fall correctly?
1) Prevention of Falls in the Elderly
Authored by Dr Colin Tidy, 03 Jul 2016
Text by CHRISTOPHER F. SCHUETZEJAN. 2, 2018
Tania Stadsbader is a VEDA Ambassador and author of the book, “Dizzy Me” – a memoir about her journey to get a vestibular diagnosis. She’s heard it all, from hyperventilation to a brain tumour, and from laziness to Ménière’s syndrome. It took doctors almost 14 years to figure out why Tania Stadsbader felt so dizzy.
Professor Dr Margie Sharpe has personally met and chatted to Tania about her story.
She is encouraged by the determination and commitment shown by Tania in reaching out to others, to help reduce the barriers to a patient’s correct diagnosis.
In fact, Professor Dr Margie Sharpe encourages all Doctors and Physiotherapists to reach a better understanding of these conditions for their own practice. She further suggests for example, organisations such as the Australian Medical Association make educational materials, sessions and learnings available to ensure better awareness within the medico industry.
It is an unfortunate truth for some people to experience long journey’s before a correct diagnosis becomes evident. Before the age of 60, 30-40% of us are challenged by some form of vestibular disorder. Currently, under 25% of vestibular patients receive successful medical care.
By writing the book Dizzy Me, Tania, and her co-author Professor Floris Wuyts have teamed up to endeavour to change this situation. Their book gathers knowledge about 12 vestibular conditions to make both diagnosis and treatment easier.
Here is Tania’s story in her own words – and Margie thanks her immensely for this article.
“I am a Belgian ex-patient who wrestled with BPPV (Benign Paroxysmal Position Vertigo) for 15 years before undergoing a canal plugging surgery that cured my balance disorder. The posterior semicircular canal is partitioned or plugged with small bone chips and human fibrinogen glue to stop the movement of endolymph and foreign particles within the canal so that the canal no longer sends false signals to the brain due to BPPV.
Today I am 47 and healthy with a career, but I do realize I was very lucky to find someone who finally helped me. My BPPV started when I was 23 and only ended at the age of 38. But in 2008 I finally recovered 100% thanks to the surgery. It was Professor Floris Wuyts, a medical physicist specialized in dizziness who guided me in my search for the diagnosis and cure.
Wuyts even guided me twice to the right diagnosis and treatment. In 2015 I underwent a nose and sinus surgery. As a result of the anesthesia and belladonna intake – which I did on own initiative because of the headaches – I experienced VP (Vestibular Paroxysmia) for 10 days. The underlying cause of Vestibular Paroxysmia is a neurovascular conflict, in which a blood vessel touches or compresses the vestibulocochlear nerve (N VIII). It was a horrible flash-back to my 15 years of illness. But this time I recovered very quickly thanks to immediate diagnosis.
VP symptoms are repeated brief attacks of vertigo or dizziness, typically lasting a few seconds to several minutes and occurring several times a day. The attacks occur spontaneously or are triggered by certain head movements. The latter makes the entity difficult to distinguish from BPPV. Possible additional symptoms are short-lasting tinnitus and hearing loss. Between the attacks, mild to moderate hearing loss and balance may occur, which makes it difficult to distinguish from Ménière’s Disease (MD). Spontaneously occurring short spells of dizziness also occur with Vestibular Migraine (VM), making it even more challenging to diagnose VP correctly.
My life story became my mission. As a change-maker in medicine and VEDA ambassador I now work with doctors and patients to raise awareness about all vestibular conditions. I wrote a book under the name Dizzy Me in which I look back on a long search for a proper diagnosis, the impact of 14 years of misdiagnosis and the 15 years of BPPV illness. I asked Floris Wuyts to become my co-author.
I tell my story directly and clearly, and also give a voice to many of my fellow sufferers, all with different disorders. Wuyts provides an extensive framework on the balance system, from anatomy, testing to 12 different disorders including clinical signs and therapy. The groundbreaking combination of patients’ and professionals’ voices makes this volume unique of its type.”
“Dizzy Me. Shedding light on balance” Oct. 2017, Kügler Publications, ISBN 987-90-6299-265-2.