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Mal de Débarquement Syndrome (MdDS) is a rare neurological disorder where individuals experience a persistent sensation of rocking, swaying, or bobbing, most typically after travel on a boat, but can also happen after travelling by plane, or other motion-based activity. Unlike typical motion sickness, this condition does not improve with time on solid ground and can last for weeks, months, and even longer. The exact cause is not fully understood, but it is believed to be related to the brain’s inability to readjust after prolonged exposure to passive motion.

While anyone can develop MdDS, it is more commonly reported in middle-aged women. The condition can significantly impact daily life, making activities such as walking, driving, or even standing still challenging. Due to its rarity and limited research, many individuals struggle to receive an accurate diagnosis.

Signs & Symptoms

The hallmark symptom of MdDS is a persistent sensation of motion, even when stationary. Unlike vertigo, which involves a spinning sensation, MdDS presents as a feeling of:

  • Rocking
  • Swaying
  • Bobbing
  • Disequilibrium

Additional symptoms may include:

  • Unsteadiness or difficulty with balance
  • Brain fog or difficulty concentrating
  • Fatigue
  • Nausea
  • Anxiety or depression
  • Sensitivity to busy visual environments (e.g., supermarkets, scrolling screens)
  • Worsening symptoms when sitting or lying still

Most individuals report temporary relief when in motion, such as driving or walking, which is a key distinguishing feature of MdDS.

Causes and Contributing Factors

The exact cause of MdDS is unknown, but it is most commonly triggered by prolonged exposure to passive motion. Potential triggers include:

  • Travel: Long boat trips, cruises, flights, or train rides
  • Virtual motion: Extended use of screens, virtual reality, or motion simulators
  • Vestibular dysfunction: Pre-existing issues with the inner ear balance system
  • Stress and hormonal factors: More common in middle-aged women, suggesting a possible link to hormonal changes

In rare cases, MdDS can occur spontaneously, without any clear trigger.

Grading

MdDS is not typically classified into specific grades, but it is often described based on duration and severity:

  • Acute MdDS: Symptoms last days to a few weeks after travel
  • Persistent MdDS: Symptoms last for months or years
  • Spontaneous MdDS: Symptoms occur without prior travel or motion exposure

Prognosis

The outlook for MdDS varies. Some individuals recover within weeks, while others experience symptoms for years. Factors influencing prognosis include:

  • Early diagnosis and management
  • Symptom severity
  • Response to treatment

For some, symptoms gradually diminish over time, while others may experience periodic relapses.

Treatment

There is no definitive cure for MdDS, but several treatment approaches can help manage symptoms and improve quality of life.

Physiotherapy and Rehabilitation

Vestibular physiotherapy may be beneficial for some individuals, particularly exercises aimed at neuroplasticity (the brain’s ability to adapt and rewire itself). Techniques may include:

  • Vestibular habituation exercises: Designed to desensitise the brain to motion
  • Balance training: Improving postural control and stability
  • Gaze stabilisation exercises: Enhancing visual-vestibular integration

Vestibular and Cognitive Therapy

  • Repetitive Optokinetic Stimulation (ROST): A therapy involving controlled visual motion to retrain the brain
  • Cognitive Behavioural Therapy (CBT): Addressing anxiety and stress, which can worsen symptoms

Medications

With seeking advice from a GP, the following individuals may benefit from:

  • Benzodiazepines (e.g., clonazepam): Used short-term for symptom relief
  • SSRIs or SNRIs: Managing anxiety and depression associated with MdDS
  • Calcium channel blockers: May help in some cases

Lifestyle Modifications

  • Regular exercise: Low-impact activities like walking or swimming
  • Stress management: Yoga, meditation, and relaxation techniques
  • Adequate sleep: Poor sleep can worsen symptoms
  • Avoiding triggers: Reducing screen time and minimising exposure to busy visual environments