Update on Therapies for Mal de Debarquement Syndrome

Purpose of Review This review will discuss current treatment options for mal de debarquement syndrome (MdDS) and non-motion triggered persistent oscillating vertigo (nmPOV). Therapies available in most clinical settings such as modifying homeostatic factors (sleep, stress, menstrual cycle, visual stimulation), medications (benzodiazepines, serotonin reuptake inhibitors), and vestibular/physical therapy are discussed. Travel precautions should incorporate these homeostatic factors and treatment options to minimize exacerbations. Recent Findings Recent data on the association between MdDS/nmPOV and vestibular migraine as well as experimental therapies including vestibulo-ocular reflex readaptation and non-invasive brain stimulation including repetitive transcranial magnetic stimulation and transcranial alternating current stimulation will be covered. Emerging ideas of oscillating vertigo as a manifestation of extracranial venous stenosis are proposed as a potential underlying etiology for these rhythmic perceptions, especially in cases occurring in the setting of overuse injury or trauma to the neck and upper chest causing cervical mal-alignment, muscle spasm, and vascular compression. MdDS and nmPOV are disorders with high morbidity but can be managed with a combination of homeostatic modifications, medications, and precautions for travel. The evolution of experimental therapies coupled with emerging ideas on a vascular pathogenesis may provide new avenues of treatment not currently employed.