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Improvements in Cognition, Balance, and Graded Symptom Checklist Score in a Patient with Mal de Debarquement Syndrome

Emily Kalambaheti1, 2, Mia Cozart2, 3, Frederick R. Carrick4, 5, 6, 7 and Matthew M. Antonucci1, 2, 4*
  • 1 Plasticity Brain Centers, United States
  • 2 Accelerate Multidisciplinary Neuroscience Research Center, College of Medicine, University of Central Florida, United States
  • 3 University of Central Florida, United States
  • 4 Carrick Institute, United States
  • 5 Bedfordshire Centre for Mental Health Research, University of Cambridge, United Kingdom
  • 6 University of Central Florida College of Medicine, United States
  • 7 MGH Institute of Health Professions, United States

Introduction: Mal de Debarqument Syndrome (MdDS) is a vestibular disorder that affects balance, cognition and motor speed (Clark 2013) The subject of this report, a 37-year-old female patient, presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms following a recent diagnosis of Mal de Debarquement Syndrome. Her symptoms occurred after air travel and included a constant feeling of movement, visual sensitivity, and brain fog. Findings: Upon intake, she reported on the graded symptom checklist (GSC) (Simon 2017) 24 symptoms accumulating to a symptom severity score of 89. During neurocognitive testing on the C3 Logix program, her Trail Making Test (TMT) was scored at 27.2 seconds; 43.7 seconds (TMT-A; TMT-B); simple reaction time was 391 milliseconds, and choice reaction time was 538 milliseconds. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing balance and stability, on both a solid and foamed surface, with eyes opened, eyes closed, and with multiple head positions. An average stability score upon intake was calculated as 50.569% (healthy reference 74.0%). Methods: A 5-day, multi-modal program of neurological exercises was administered in 10 one-hour treatment sessions, similar to Carrick 2017. Each session consisted of repetitive peripheral somatosensory stimuli, cognitive exercises, neuromuscular reeducation exercises, vestibular rehabilitation exercises, orthoptic exercises, and off-vertical axis rotation utilizing a multi-axis rotational chair (MARC; ReNeuro Robotics, Dallas, TX, USA).  Outcome: Upon exit, the symptom severity score decreased to 13 (-85.39%) with complete resolution of 12 symptoms (-50.00%); TMT-A decreased to 19.0 (-30.15%); TMT-B decreased to 30.0 seconds (-31.35%). Simple and choice reaction times improved to 315 ms (-19.44%) and 418ms (-22.30%) milliseconds. Stability scores improved, with the average stability score calculated as 78.611% (+55.45%). Conclusion: This report describes the results of a 5-day intensive, multi-modal neuro-rehabilitation program in a female with MdDS. The authors suggest further investigation into multi-modal, intensive approaches to improve cognition, balance, and symptom severity and number in patients with Mal de Debarquement Syndrome.

Acknowledgements

The authors would like to thank the staff of Plasticity Brain Centers for their assistance in the care of this patient.

References

Carrick FR, Clark JF, Pagnacco G, Antonucci MM, Hankir A, Zaman R, and Oggero E (2017) Head–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients. Front. Neurol. 8:414. doi: 10.3389/fneur.2017.00414 Clark BC, LePorte A, Clark S, Hoffman RL, Quick A, Wilson TE, et al. Effects of persistent Mal de Debarquement Syndrome on balance, psychological traits, and motor cortex excitability. J Clin Neurosci(2013) 20:446–50.10.1016/j.jocn.2012.06.004 Pagnacco G, Carrick FR, Wright CH, Oggero E. In-situ verification of accuracy, precision and resolution of force and balance platforms. Biomed Sciences instrumentation (2014) 50:171-8 Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod TV. Reliability and on current Validity of Select C3 Logix Test Components. Developmental Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.

Keywords: Mal de Debarquement Syndrome (MdDS), Neurorehabilitation, vestibular rehabilitaiton, Cognition, Intensive rehabilitation

Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.

Presentation Type: Poster Presentation

Topic: Clinical Neuroscience

Citation: Kalambaheti E, Cozart M, Carrick FR and Antonucci MM (2019). Improvements in Cognition, Balance, and Graded Symptom Checklist Score in a Patient with Mal de Debarquement Syndrome. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00080

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Received: 17 May 2019; Published Online: 27 Sep 2019.

* Correspondence: Dr. Matthew M Antonucci, Carrick Institute, Cape Canaveral, Florida, 32920, United States, drnucci@gmail.com