Transcranial Magnetic Stimulation as Treatment for Mal de Debarquement Syndrome: Case Report and Literature Review.

This manuscript presents the case of an adult, male patient with mal de debarquement syndrome (MdDS); results from his experimental treatment with repetitive transcranial magnetic stimulation (rTMS) are also provided. Additionally, we included a review of literature related to the neurophysiology of MdDS and its treatment with rTMS. A 41-year-old man had been experiencing symptoms of MdDS, which initially emerged following a car ride, for 11 to 12 years. Pharmacologic approaches had failed to provide symptom relief; thus, we investigated an intervention using low-frequency (1 Hz) rTMS unilaterally for 2 consecutive weeks. The outcome measures included a standardized, computerized dynamic posturography test to quantify the patient's balance and identify abnormalities in his use of the sensory systems contributing to postural control, as well as the Hospital Anxiety and Depression Scale (HADS) to measure his anxiety and depression. An rTMS treatment log was created to document any adverse events. Following rTMS, the patient's balance scores improved significantly; these improvements were mostly related to the patient's increased reliance on the visual and vestibular systems. Our patient's HADS Anxiety and Depression subscores also showed improvement post-rTMS. The presented case study provides preliminary evidence that rTMS may be a noninvasive treatment option for improving balance, specifically in individuals with MdDS. This evidence can be used to further therapeutic research on, and provide strategies for treating, MdDS.

Executive functioning as a predictor of stroke rehabilitation outcomes.

Objective: Stroke is a common cause of death and adult chronic neurologic disability. Although factors such as cardiovascular disease affect the incidence of stroke, less is known about factors influencing longitudinal stroke outcomes. The purpose of this research was to assess the contribution of executive functioning (EF) at discharge to the prediction of functional status at several timepoints between discharge from a stroke rehabilitation unit and 12 months, in comparison with depression, mental status, comorbidity, and pain at discharge, and daily functioning prior to admission. Methods: The sample comprised 246 inpatients aged 65 and older who were on inpatient rehabilitation services following acute hospitalization for a stroke. Patients (or proxies) were interviewed in person at discharge about their ability to engage in activities of daily living (ADL), and by telephone at follow-ups 3, 6, 9, and 12 months after discharge. Functional outcomes included independence in bathing, dressing, walking, use of the toilet, and chair/bed transfers. Hypotheses were tested concerning the relative contribution of EF, depression, mental status, comorbidity, and several other demographic and clinical variables to ADL performance. Results: Executive functioning, depression, and pre-admission ADL functioning were strong predictors of outcome at all five timepoints, while neither comorbidity nor mental status were retained in any regression models. Pain at discharge was a significant predictor at discharge and 6 month follow-up. Conclusions: Executive functioning and depression are robust predictors of functional status following stroke rehabilitation. Although not consistently a significant predictor, pain might also be a useful addition to predictive models.