Examination of Current Treatments and Symptom Management Strategies Used by Patients With Mal De Debarquement Syndrome

Introduction: Mal de Debarquement Syndrome (MdDS) is a neurological disorder which affects the vestibular system pathways, manifesting as a constant sensation of movement in the form of rocking, bobbing, or swaying. The mechanism of MdDS is poorly understood and there is a lack of awareness amongst medical professionals about the condition. This study aimed to examine treatments and symptom management strategies used by MdDS patients and evaluate their self-reported effectiveness.Method: Motion-Triggered and Spontaneous/Other onset MdDS patients responded to a set of comprehensive questions as a retrospective survey regarding epidemiological details, diagnostic procedures, onset, and symptom triggers, hormonal influences as well as treatments and symptom management strategies used to reduce symptoms. The Motion-Triggered questionnaire was made available through Survey Monkey and the Spontaneous/Other Onset questionnaire through Qualtrics. The link for each questionnaire was made available on online MdDS support groups and on various research websites. Descriptive statistics were used for epidemiological data and Pearson's Chi Square tests were used for comparisons between and within both subtype groups.Results: A total of 370 patients participated in the surveys, with 287 valid responses collected for the section regarding treatment and symptom management strategies. The success of the treatments and symptom management strategies did not vary between subtypes Benzodiazepines/Antidepressants were reported as being most beneficial in reducing symptoms in both groups.Conclusion: This was the first attempt to evaluate the reported success of treatments and symptom management strategies in MdDS patients by assessing the patients' perceived helpfulness. The treatments and symptom management strategies reported to be the most helpful in managing and/or reducing symptoms are proposed to be effective due to their stress-reducing capacities. We hope this study will broaden MdDS awareness and that this study will increase patient knowledge regarding treatments and symptom management strategies that other patients found helpful

Effectiveness of non-pharmacological treatments for vestibular and oculomotor dysfunction in patients with persistent post-concussive symptoms : protocol for a systematic review and meta-analysis

Introduction: Concussion is a form of mild traumatic brain injury that disrupts brain function. Although symptoms are mostly transient, recovery can be delayed and result in persistent postconcussive symptoms (PPCS). Vestibular and oculomotor dysfunction are among the most debilitating impairments associated with PPCS. However, pharmacological interventions for these impairments are associated with deleterious side effects. Accordingly, increasing research has examined the utility of non-pharmacological interventions for PPCS. The aim of this review is to synthesise and evaluate the effectiveness of non-pharmacological interventions for the treatment of vestibular and oculomotor dysfunction for patients with PPCS. Methods and analysis: Systematic searches of MEDLINE, PubMed, Web of Science and Scopus will identify randomised controlled trials employing non-pharmacological treatments for vestibular and/or oculomotor dysfunction for PPCS. Such interventions may include, but are not limited to, vestibular rehabilitation, optokinetic stimulation and vestibulo-ocular reflex exercises. Assessments of oculomotor function will include versional eye movements, vergence eye movements, visual-fixation movements and accommodation response. Assessments of vestibular function will include the Fukuda Step test, functional balance tests, force displacement tests, and subjective reports of balance disruption or vertigo. Where appropriate, meta-analyses of standardised mean differences will be conducted using a random effects model for continuous outcomes. For dichotomous outcomes (improved vs not improved following treatment), effects will be expressed as relative risk. The impact of heterogeneity will be calculated using the I2 statistic. The Physiotherapy Evidence Database scale will be used to determine the methodological quality of individual studies and Grading of Recommendations, Assessment, Development and Evaluations used to assess the certainty and quality of evidence for each outcome. Ethics and dissemination: Ethical approval is not required for this review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO registration number: CRD42021254720

Vestibular disability/handicap in Fibromyalgia : a questionnaire study

Fibromyalgia (FM) is a poorly understood, central pain processing disorder characterized by a broad range of symptoms, such as chronic pain, sleep disruption, chronic fatigue, and psychosomatic symptoms. In addition, recent studies have shown that FM patients also experience dizziness. We aimed to establish a prevalence rate of vestibular symptoms in a population of FM patients through a battery of questionnaires investigating socio-demographic, clinical and psychological characteristics, combined with the Dizziness Handicap Inventory (DHI) and the Situational Vertigo Questionnaire (SVQ). A total of 277 respondents, officially diagnosed with FM, completed the full study, while 80 controls were also included for DHI and SVQ questionnaires. We found that FM participants were significantly affected by vestibular symptoms, which correlated with FM-associated pain and non-pain symptoms. The dizziness reported by FM participants showed peculiar features suggesting an FM-intrinsic mechanism of vestibular dysfunction, possibly linked to migraine and dysautonomia conditions. Correlations between dizziness and depressive mood (or neuroticism), revealed an impact of dizziness on psychological status, leading to depressive reactions and interpersonal difficulties, and possibly involving a noxious, self-sustained stress condition. In conclusion, data showed a manifesting dizziness condition in FM patients that warrants careful clinical attention due to its possible inherent role in the syndrome

Visual disorders and mal de debarquement syndrome : a potential comorbidity questionnaire-based study

Aim: Mal de debarquement syndrome (MdDS) is a neurological condition characterized by a constant sensation of self-motion; onset may be motion-triggered (MT) or non-motion-triggered/spontaneous (NMT/SO). People with MdDS experience similar symptoms to those with vertical heterophoria, a subset of binocular visual dysfunction. Hence, we aimed to explore potential visual symptom overlaps. Methods: MdDS patients (n=196) and controls (n=197) completed a visual health questionnaire. Results: Compared with controls, the MdDS group demonstrated higher visual disorder scores and visual complaints. NMT/SO participants reported unique visual symptoms and a higher prevalence of mild traumatic brain injury. Conclusion: Our findings suggest visual disorders may coexist with MdDS, particularly the NMT/SO subtype. The difference in visual dysfunction frequency and medical histories between subtypes, warrants further investigation into differing pathophysiological mechanisms. Plain language summary: MdDS is a condition where patients feel like they are always on a boat. It is typically triggered by passive motion-events (cruises, flights, etc.), but can develop after non-motion events. People with MdDS can experience symptoms like those with certain visual disorders, therefore we wanted to see if there were overlaps between these conditions. This study surveyed people with MdDS and individuals from the general population about visual health and found that the MdDS group reported a higher frequency of visual dysfunction symptoms. Compared with motion-triggered patients, non-motion patients reported unique visual symptoms. This demonstrates that visual disorders may coexist in MdDS. Tweetable abstract: Mal de debarquement syndrome #MdDS is a rare condition where patients feel like they are always on a boat. Given the overlap of symptoms between MdDS and a common visual disorder– these researchers turned their focus toward visual comorbidities and found some eye-raising results

Sham-Controlled Study of Optokinetic Stimuli as Treatment for Mal de Debarquement Syndrome

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

Tracking the Expression of Excitatory and Inhibitory Neurotransmission-Related Proteins and Neuroplasticity Markers after Noise Induced Hearing Loss

Excessive exposure to loud noise can damage the cochlea and create a hearing loss. These pathologies coincide with a range of CNS changes including reorganisation of frequency representation, alterations in the pattern of spontaneous activity and changed expression of excitatory and inhibitory neurotransmitters. Moreover, damage to the cochlea is often accompanied by acoustic disorders such as hyperacusis and tinnitus, suggesting that one or more of these neuronal changes may be involved in these disorders, although the mechanisms remain unknown. We tested the hypothesis that excessive noise exposure increases expression of markers of excitation and plasticity, and decreases expression of inhibitory markers over a 32-day recovery period. Adult rats (n = 25) were monaurally exposed to a loud noise (16 kHz, 1/10th octave band pass (115 dB SPL)) for 1-hour, or left as non-exposed controls (n = 5). Animals were euthanased at either 0, 4, 8, 16 or 32 days following acoustic trauma. We used Western Blots to quantify protein levels of GABAA receptor subunit α1 (GABAAα1), Glutamic-Acid Decarboxylase-67 (GAD-67), N-Methyl-D-Aspartate receptor subunit 2A (NR2A), Calbindin (Calb1) and Growth Associated Protein 43 (GAP-43) in the Auditory Cortex (AC), Inferior Colliculus (IC) and Dorsal Cochlear Nucleus (DCN). Compared to sham-exposed controls, noise-exposed animals had significantly (p<0.05): lower levels of GABAAα1 in the contralateral AC at day-16 and day-32, lower levels of GAD-67 in the ipsilateral DCN at day-4, lower levels of Calb1 in the ipsilateral DCN at day-0, lower levels of GABAAα1 in the ipsilateral AC at day-4 and day-32. GAP-43 was reduced in the ipsilateral AC for the duration of the experiment. These complex fluctuations in protein expression suggests that for at least a month following acoustic trauma the auditory system is adapting to a new pattern of sensory input

Assessing the engagement rates and satisfaction levels of various clinical health science student sub-groups using supplementary elearning resources in an introductory anatomy and physiology unit

Purpose: Introductory anatomy and physiology provide a core knowledge base to students within clinical health science courses. Increased student numbers, as well as reduced access to laboratory-based cadaveric resources, have created a need for enhanced learning approaches to support learning. The streamlining of courses has also resulted in the need to effectively engage course sub-groups within large units. The purpose of this paper is to utilize the eLearning activities to investigate engagement and satisfaction levels within students undertaking an anatomy and physiology unit. Design/methodology/approach: A total of 19 formative quizzes were made available to students. Online practical anatomy laboratories covered anatomical content, and physiology quizzes covered physiological content. Student engagement was compared using frequency analysis across students studying varying courses. Satisfaction was determined by analyzing student’s feedback using frequency analysis. Findings: Students accessed the learning activities 29,898 times over semester, with the peak access (37 percent) prior to the closed book exams. The resources were utilized primarily as an exam preparation tool rather than consistently throughout semester. Out of the various courses, the Paramedicine, Physiotherapy and Podiatry students were the most engaged, with the highest percent of “engaged/highly engaged” students. Students from various courses shared very similar views of the perceived benefit of the eLearning activities. Practical implications: These results indicated a difference in engagement levels between the students of various course sub-groups, and therefore suggests that the development of course-specific eLearning activities is necessary in large, streamlined units to achieve a more focused approach to support students’ learning, engagement and success, so that positive and beneficial learning experiences are ensured for all students. Originality/value: These results suggest that in the future, development of eLearning activities is necessary to achieve a more focused approach to support students’ learning, engagement and success, so that positive and beneficial learning experiences are ensured for all

Understanding the underlying mechanisms of noise-induced hearing loss : a molecular and physiological approach

The main purpose of this thesis was to investigate the physiological, molecular and behavioural consequences of unilateral noise-induced hearing loss. In particular, how these properties develop in the month following noise-induced hearing loss. These investigations have implications for the generation of associated acoustic disorders, such as tinnitus and possibly hyperacusis. Tinnitus is the sensation of a sound when no external sound source is present. It is estimated to affect 10-17% of adults worldwide. There are many ways in which tinnitus can be generated; however noise-induced hearing loss is the most common cause and is increasingly apparent in individuals across all age groups. Most individuals in today‘s society are exposed to damaging levels of noise on a regular basis; at the workplace, at concerts and the use of personal listening devices. It is understood that tinnitus is a disorder of the auditory system, but the neural mechanisms remain unknown. Excessive levels of noise can cause damage to the cochlea, which can result in premature deafness and noise-induced hearing loss. This damage causes a range of changes in the auditory pathway. Changes observed include plasticity of tonotopic representation, changes in auditory neuron physiology, changes in the pattern of spontaneous activity and changes in the balance of excitatory and inhibitory transmitter systems. Moreover, damage to the cochlea frequently results in tinnitus. This suggests that one or more of these changes may be involved in tinnitus generation. This thesis has investigated the one month time-course changes of molecular, physiological and behavioural changes in the young adult rat after NIHL. This investigation has presented novel findings that significant time-dependent changes occur in the auditory pathway after NIHL. The physiological changes over the one month time-course reflect a constant compensatory mechanism between excitability and SA; the molecular changes indicate fluctuations in excitatory and inhibitory neurotransmission-related systems over the one month time-course and the behavioural manifestations of tinnitus highlight the variability of animals‘ perceptions after NIHL. This study has proposed that the Day 8 time-point may be a crucial period after NIHL, whereby the auditory system attains a state of partial recovery. Interpreting these mechanisms will be crucial for understanding the generation and development of acoustic disorders such as tinnitus and hyperacusis, and potentially the development of a therapeutic intervention

Influence of sex hormones on vestibular disorders

Purpose of review: Vestibular disorders are gender distributed with a higher prevalence in women. Although research has increased in this field, the mechanisms underlying this unbalance is unclear. This review summarises recent advances in this research sphere, and briefly discusses sex hormone effects on various vestibular conditions and highlights some recent theories. Recent findings Recent work has identified a direct link between aberrant gonadal hormone levels and vestibular dysfunction. Benign paroxysmal positional vertigo research suggests that the disorder may be linked to the rapid decrease in oestrogen, observed in menopausal women, which disrupts otoconial metabolism within the inner ear. A successful hormonal therapeutic intervention study has advanced our knowledge of hormonal influences in the inner ear in Meniere’s disease. Also, several studies have focused on potential mechanisms involved in the interaction between Vestibular Migraine, Mal de Debarquement Syndrome, and gonadal hormones. Summary: In females, gonadal hormones and sex-specific synaptic plasticity may play a significant role in the underlying pathophysiology of peripheral and central vestibular disorders. Overall, this review concludes that clinical assessment of female vestibular patients requires a multifaceted approach which includes auditory and vestibular medicine physicians, gynaecologists and/or endocrinologists, in conjunction with hormonal profile evaluations

Measuring the value of a digital supplemental resource

Supplemental resources in science education are made available to students based on the belief that they will improve coursebased student learning. This belief is ubiquitous, with supplemental resources being a traditional component of physiology education. In addition, the recent large-scale transition to remote learning caused by the Covid-19 pandemic suggests an increased relevance and necessity of digital versions of supplemental resources. However, the use of a supplemental resource is entirely dependent on whether students view it as beneficial. If students in a specific course do not perceive a supplemental resource as useful, there is little reason to believe the resources will be used and are worthy of investment. Consequently, measurement of student perception regarding the effectiveness of any digital learning tool is essential for educators and institutions in order to prioritize resources and make meaningful recommendations to students. In this study, a survey was used to determine student perceptions of a digital, supplemental resource. Quantitative methods, including exploratory factor analysis, were performed on data collected from the survey to examine the dimensionality and functionality of this survey. The findings from this study were used to devise an improved, standardized (i.e., reliable and valid) survey that can be used and adapted by physi3ology researchers and educators to determine student perception of a digital supplemental resource. The survey, with known construct validity and internal reliability, can provide useful information for administrators, instructors, and designers of digital supplemental resources