DevRobust Treatment for Mal de Débarquement Syndrome

Objectives This study aims to improve outcomes of MdDS by broadening its treatment options. Specifically, to improve access to the VOR readaptation treatment, the investigators will test the efficacy of VR goggles in generating visual motion to treat MdDS. If proven to be effective, MdDS patients can be treated locally in many vestibular therapy offices, not only for initial treatment but also for remedial or follow-up treatment when symptoms return. To improve long-term outcomes of MdDS, the investigators will evaluate the efficacy of the treatment of a complementary approach combined with VOR readaptation. The investigators hypothesize that an additional intervention that reduces (habituates) the velocity storage capacity will decrease sensitivity to physical movement and improves MdDS symptoms as well as limits symptom recurrence. In addition the investigators hypothesize that desensitization to visual stimuli can reduce visually induced dizziness frequently observed in patients with MdDS. The investigators will verify whether these complementary treatments will provide a better outcome compared to the readaptation treatment by itself. Lastly, to broaden the scope of the VOR readaptation treatment, the study will address the false sensation of gravitational pull commonly reported by patients. The investigators also hypothesize that a visual motion stimulus without cross-axis head motion can reduce this sensation.

Specific Aims Specific Aim 1: Evaluate the efficacy of VR goggles for VOR readaptation. One hundred patients with oscillatory self-motion sensations will be randomly assigned to undergo VOR readaptation with full-field OKS (Group 1, n=50) or VR goggles (Group 2, n=50). Immediate and up to six-month follow-up results will be compared.

Specific Aim 2: Evaluate the efficacy of habituation and visual desensitization combined with VOR readaptation. Sixty patients with oscillatory self-motion sensations will be randomly assigned to undergo VOR readaptation with full-field OKS combined with a habituation (Group 3, n=30) or visual desensitization (Group 4, n=30) protocol. Immediate and up to six-month follow-up results will be compared to those of Group 1.

Specific Aim 3: Treatment of gravitational pull sensation. The investigators estimate that 40 of 200 patients screened for this study will have a phantom sensation dominated by gravity pull, 20 with only that sensation. These patients will be randomly assigned to undergo OKS in a full-field (Group 5, n=20) or VR setting (Group 6, n=20). Immediate and up to six-month follow-up results will be compared.

How Research Will Be Introduced to Participants:

The study will be introduced to potential participants through public announcements such as ClinicalTrials.gov, referrals from clinicians, or direct contact by investigators to individuals who previously requested to be contacted for the opportunity to participate in an MdDS treatment study.

How Participants Will Be Screened:

Informed consent form will be emailed to individuals interested in study participation. Individuals will be contacted by the investigators over the phone and consented for study participation. Consented potential participants will receive intake forms via email with questions regarding the history and symptom characteristics of MdDS, age, sex, and general medical history. Investigators will review the returned intake forms to determine eligibility for study participation based on the inclusion/exclusion criteria described separately and a telephone interview for confirmation and clarification of the candidate's MdDS symptoms. A nystagmography test will then be requested to verify normal inner ear and central vestibular functioning. When candidates do not qualify for the study, screening data will be de-identified, and only those about MdDS symptom presentation, age, sex, and the reason for exclusion will be kept. Intake form and the nystagmography report of the candidates will be securely transferred to NYU for Dr. Catherine Cho to review. Dr. Cho will then conduct a telephone interview with each candidate, and provide PI with confirmation or denial of candidate eligibility, after which the information reviewed by Dr. Cho will be destroyed.

Inclusion criteria

• Conformable diagnosis of Mal de Débarquement Syndrome including significant improvement of symptoms with passive motion.

Exclusion criteria

• A history of abnormal inner ear or central vestibular function indicated by abnormal nystagmography test (abnormal saccades or pursuit, VOR suppression index <85%, no caloric response, decay time constant of response to rotation less than 10 seconds, spontaneous nystagmus).
• Confounding neurological disorders (e.g., multiple sclerosis, Parkinson's, epilepsy, blindness etc.).
• A history of leg, spine, or other injuries that affect their ability to stand or walk without assisting support.
• High level of anxiety as indicated by State-Trait Anxiety Inventory (≥75) and the Beck Anxiety Inventory (≥55).
• Claustrophobia.
• Patients previously treated with VOR readaptation technique are excluded.