Virtual reality application matches the most established treatment for Mal de Debarquement Syndrome: A non-inferiority, randomized, open clinical trial.

Mal de Debarquement Syndrome (MdDS) is a debilitating neuro-otological disorder where individuals consistently feel self-motion, often triggered by motion like being on a boat (MT-MdDS). Due to the unknown pathophysiological mechanism, available treatment options for managing symptoms are limited. Our objective was to develop a virtual reality application (VRA) to simulate the full field optokinetic stimulation (OKS) booth and evaluate its efficacy compared to the standard treatment. In our randomized, open, non-inferiority clinical trial with 30 â€‹MT-MdDS patients, 15 received the OKS booth and 15 the new VRA over four consecutive days. Two 4-min treatment blocks were scheduled in the morning and afternoon, with a total of four blocks. Treatment effectiveness was evaluated through questionnaires and posturography. Our findings suggest that the choice of modality does not significantly differ in achieving an overall improvement in symptoms. We advocate that the VRA can be used as an accessible alternative to the booth method worldwide, effectively mitigating MdDS symptoms and enhancing the QoL of numerous MdDS patients.

Guideline for standardized approach in the treatment of the Mal de Debarquement syndrome.

Introduction: Mal de Debarquement Syndrome (MdDS) is a debilitating neuro-otological disorder. Patients experience almost continuously a perception of self-motion. This syndrome can be motion-triggered (MT-MdDS), such as on a boat, or occur spontaneously or have other triggers (SO-MdDS) in the absence of such motion. Because the pathophysiological mechanism is unknown, treatment options and symptom management strategies are limited. One available treatment protocol involves a readaptation of the vestibular ocular reflex (VOR). This study assesses the effectiveness of vestibulo-ocular reflex (VOR) readaptation in 131 consecutive patients with a fixed protocol. Methods: We administered 131 treatments involving optokinetic stimulation (OKS) paired with a fixed head roll at 0.167 Hz over two to five consecutive days. Each day, four-minute treatment blocks were scheduled twice in the morning and afternoon. Treatment effectiveness was evaluated through questionnaires and posturography. Results: We observed significant improvements in the visual analog scale (VAS), MdDS symptom questionnaire, and posturography measures from pre- to post-treatment. No significant differences were found in outcome variables between MT- and SO-MdDS onsets. Conclusion: Symptoms improved subjectively and objectively in patients' post-treatment. The overall success rate was 64.1%, with no significant difference between MT (64.2%) and SO (63.3%). This study supports the conclusion that VOR readaptation treatment provides relief for two-thirds of MdDS patients, irrespective of the onset type. Based on consistency in the findings, we propose a standardized method for treatment of MdDS based on the OKS with head roll paradigm.

Presbivestibulopatía: criterios diagnósticos. Documento de consenso del Comité de Clasificación de la Bárány Society / Presbyvestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society

Este artículo describe los criterios diagnósticos de presbivestíbulopatía (PVP) del Comité de Clasificación de la Sociedad Bárány. Se define la PVP como un síndrome vestibular crónico, caracterizado por inestabilidad, alteración de la marcha, y/o caídas recurrentes en presencia de déficits vestibulares bilaterales leves, con hallazgos en las pruebas de función vestibular situados entre la normalidad y los límites establecidos para la vestibulopatía bilateral. El diagnóstico de PVP se basa en la anamnesis, la exploración clínica y la evaluación mediante pruebas de función vestibular. El diagnóstico de PVP requiere una reducción bilateral de la función del reflejo vestíbulo-ocular (RVO). Esta puede ser diagnosticada mediante el video-HIT (vHIT) para el rango de frecuencias altas del RVO; para el rango de frecuencias medias con la prueba de la silla rotatoria; y para el rango de bajas frecuencias mediante la prueba calórica. Para el diagnóstico de PVP, la ganancia de RVO angular horizontal debe ser en ambos lados < 0,8 y > 0,6, y/o la suma de las velocidades pico máximas de fase lenta del nistagmo calórico, tras estimulación con agua caliente y fría en cada lado, que debe estar entre < 25°/s y > 6°/s y/o la ganancia del RVO angular horizontal debe estar entre > 0,1 y < 0,3 con la estimulación sinusoidal en silla rotatoria. La PVP habitualmente ocurre junto con otros déficits relacionados con la edad que afectan a la visión, propiocepción, y/o de las funciones corticales, cerebelosas y extrapiramidales que también contribuyen y que podrían incluso ser necesarias para la manifestación de los síntomas de inestabilidad, alteración de la marcha y caídas. Estos criterios consideran simplemente la presencia de estos síntomas en adultos mayores, junto con el deterioro documentado de la función vestibular. (AU)

This paper describes the diagnostic criteria for presbyvestibulopathy (PVP) of the Classification Committee of the Bárány Society. PVP is defined as a chronic vestibular syndrome characterized by unsteadiness, gait disturbance, and/or recurrent falls in the presence of mild bilateral vestibular deficits, with findings on laboratory tests that are between normal values and the thresholds established for bilateral vestibulopathy. The diagnosis of PVP is based on patient history, bedside examination, and laboratory evaluation. The diagnosis of PVP requires bilaterally reduced function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the VOR with video-HIT (vHIT), for the middle frequency range with rotary chair testing, and for the low frequency range with caloric testing. For the diagnosis of PVP, the horizontal angular VOR gain on both sides should be < .8 and > .6, and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side should be < 25°/s and > 6°/s, and/or the horizontal angular VOR gain should be > .1 and < .3 upon sinusoidal stimulation on a rotatory chair. PVP typically occurs along with other age-related deficits of vision, proprioception, and/or cortical, cerebellar, and extrapyramidal function which also contribute to and might even be required for symptoms of unsteadiness, gait disturbance, and falls to manifest. These criteria simply consider the presence of these symptoms, along with documented impairment of vestibular function, in older adults. (AU)