Developing robust treatment options for Mal de Débarquement Syndrome

开发针对 Mal de Débarquement 综合征的稳健治疗方案

• 批准号: 10531023
• 负责人: SERGEI YAKUSHIN
• 金额: $ 52.72万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10531023
• 关键词: Address; Affective; Aftercare; Back; Chronic; Chronic Disease; Clinical; Cognitive; Complementary therapies; Controlled Study; Coupled; Custom; Data; Devices; Disease; Dizziness; Esthesia; Exposure to; Follow-Up Studies; Force of Gravity; Foundations; Frequencies; Gravitation; Head; Health Services Accessibility; Home; Hour; Improve Access; Intervention; Laboratories; Methods; Motion; Motion Sickness; Movement; New York City; Outcome; Patients; Physiological; Placebos; Predisposition; Protocols documentation; Randomized; Recurrence; Reporting; Self Perception; Shapes; Ships; Side; Signs and Symptoms; Space Perception; Symptoms; Syndrome; Telemedicine; Testing; Torsion; Transportation; Travel; Treatment Effectiveness; Treatment Protocols; Treatment outcome; Vision; Visual; Visual Fields; Visual Motion; base; clinical practice; cost; desensitization; design; efficacy evaluation; efficacy testing; equilibration disorder; experience; follow-up; habituation; improved; improved outcome; motion sensitivity; patient screening; pilot test; portability; recruit; reduce symptoms; success; symptomatic improvement; symptomatology; vestibulo-ocular reflex; virtual reality; virtual reality headset; visual stimulus

ABSTRACT: Mal de Débarquement Syndrome (MdDS) is an under-recognized but nevertheless common balance disorder, which in most cases occurs after exposure to prolonged passive motion. MdDS, a chronic illness that can last for many years, is manifested by persistent false sensations of rocking/swaying or gravitational pull. MdDS is debilitating as these symptoms and signs are typically accompanied by other presumably secondary physical, cognitive, and affective problems. In addition to motion-triggered (MT) cases, the same or indistinguishable symptoms can occur without a specific trigger, identified as spontaneous-onset (SO) MdDS. Treatment options for MdDS are limited, and it was only recently that a breakthrough was made in our clinical laboratory with physiological readaptation of the vestibulo-ocular reflex (VOR). The premise of this treatment is that MdDS is caused by maladaptation of a functional component of the VOR called velocity storage, which shapes spatial orientation and the perception of self-motion. The treatment has been administered by maneuvering the head of the patient seated inside a cylindrical chamber during a full-field optokinetic stimulation (OKS). Our current success rates immediately after treatment of MT and SO MdDS are 75% and 50%, respectively. A follow-up study indicated that the success rates later fluctuate as well as that a significant number of patients remain sensitive to bright lights, movements of visual objects, and transportation, pointing to the treatment method's limitations. A primary hurdle is access to the treatment. Full-field OKS requires a specialized set-up in a dedicated room, making the treatment possible only in several laboratories around the world. We recently successfully pilot tested the efficacy of virtual reality (VR) goggles for MdDS treatment with the readaptation approach. In this proposed project, VR goggles will be tested on a larger group of patients, and the effects will be compared to those of full-field OKS. If proven to be effective, MdDS can be treated locally to patients in many vestibular therapy offices, not only for initial treatment but also for remedial or follow-up treatment when symptoms return. This proposal also addresses the weaknesses of the VOR readaptation approach by testing complementary approaches. We hypothesize that reducing (habituating) the velocity storage capacity decreases sensitivity to physical movement and improves MdDS symptoms as well as limits symptom recurrence. We further hypothesize that desensitization to visual stimuli can reduce visually induced dizziness frequently observed in patients with MdDS. We will verify whether these complementary treatments will provide a better outcome compared to the readaptation treatment by itself. Lastly, we hypothesize that OKS without head motion can reduce the false sensation of gravitational pull commonly reported by MdDS patients. Two hundred MdDS patients will be recruited for the study. Patients will be treated for 1-2 hours a day for 5 days. Patients will be followed up with for up to 12 months. The proposed study will facilitate improved outcomes for MdDS by broadening its treatment options.

摘要： 出境综合症 (MdDS) 是一种未被充分认识但仍然很常见的疾病 平衡障碍，大多数情况下发生在长期被动运动后，这是一种慢性运动。 疾病可能持续多年，表现为持续的摇晃/摇摆或摇晃的错误感觉 MdDS 会使人衰弱，因为这些症状和体征通常伴有其他症状和体征。 据称继发性身体、认知和情感问题 除了运动触发 (MT) 病例外， 在没有特定触发因素的情况下，可能会出现相同或无法区分的症状，被识别为自发性症状 (SO) MdDS 的治疗选择有限，直到最近才取得突破。 我们的临床实验室具有前庭眼反射 (VOR) 的生理再适应能力。 治疗方法是 MdDS 是由 VOR 的功能组件（称为速度存储）适应不良引起的， 它塑造了空间定向和自我运动的感知。治疗是由以下人员进行的。 在全场视动刺激期间操纵坐在圆柱形室内的患者头部 (OKS)。我们目前 MT 和 SO MdDS 治疗后的成功率分别为 75% 和 50%， 后续研究表明，成功率随后会出现波动，并且数量很大。 的患者对强光、视觉物体的运动和交通仍然敏感，这表明 治疗方法的局限性是获得全场 OKS 需要专门的人员。 设置在专用房间中，使得这种治疗只能在世界各地的几个实验室中进行。 最近成功地对虚拟现实 (VR) 护目镜用于 MdDS 治疗的功效进行了试点测试 在这个拟议的项目中，VR 护目镜将在更多的患者身上进行测试，并且 如果证明有效，则可以将 MdDS 与全视野 OKS 的效果进行比较。 许多前庭治疗办公室的患者，不仅进行初始治疗，还进行补救或随访 该建议还解决了 VOR 重新适应的弱点。 通过测试补充方法，我们攀爬了减少（习惯）速度存储的方法。 能力降低对身体运动的敏感性，改善 MdDS 症状并限制症状 我们进一步发现，对视觉刺激的脱敏可以减少视觉引起的头晕。 经常在 MdDS 患者中观察到，我们将验证这些补充治疗是否有效。 与单独的重新适应治疗相比，结果更好。最后，我们接受了无头 OKS。 运动可以减少 200 名 MdDS 患者普遍报告的重力错误感觉。 MdDS 患者将被招募参加该研究，患者将每天接受 1-2 小时的治疗，为期 5 天。 拟议的研究将进行长达 12 个月的随访，通过以下方式促进改善 MdDS 的结果。 扩大其治疗选择。