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

基本信息

批准号：
10677732
负责人：
SERGEI YAKUSHIN
金额：
$ 47.5万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
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/10677732
关键词：
Address Affective Aftercare Back Chronic Chronic Disease Clinical Cognitive Complementary therapies Controlled Study Coupled Custom Data Dedications Devices Disease Disorientation Dizziness Esthesia Exposure to Follow-Up Studies Force of Gravity Foundations Frequencies Head Health Services Accessibility Home Hour Improve Access Intervention Laboratories Medial Methods Motion Motion Sickness Movement New York City Outcome Patients Photic Stimulation Physiological Placebos Predisposition Protocols documentation Randomized Recurrence Reporting Self Perception Shapes Side Signs and Symptoms Space Perception Symptoms Syndrome Telemedicine Testing Transportation Travel Treatment Effectiveness Treatment Protocols Treatment outcome Vision Visual Visual Fields Visual Motion 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

项目摘要

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：Mal dedébarquement综合征（MDDS）是一种不认可但仍然常见的在大多数情况下，在暴露于长时间的被动运动后发生的平衡障碍。 MDD，慢性可以持续多年的疾病表现出持续的错误摇摆/摇摆或引力拉力。 MDD正在使人衰弱，因为这些符号和符号通常伴随着其他符号大概是次要的身体，认知和情感问题。除了运动触发（MT）的情况外，没有特定的触发器，可以发生相同或难以区分的符号（因此）MDD。 MDD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）的物理读物。这个前提治疗是MDD是由称为速度存储的VOR功能成分的不良调整引起的，这塑造了空间取向和自我运动的感知。治疗已通过在全场光学动力学模拟过程中，操纵坐在圆柱室内的患者头部的头部（好的）。 MT治疗后，我们目前的成功率是75％和50％，因此分别。后续研究表明，成功率后来波动，并且数量很大患者对明亮的灯光，视觉物体的运动和运输的敏感，指向治疗方法的局限性。主要障碍是获得治疗。全场OKS需要专业在专门的房间里设置，仅在世界各地的几个实验室中才能进行治疗。我们最近，成功进行了试点测试虚拟现实（VR）护目镜的效率读取方法。在这个拟议的项目中，VR护目镜将对较大的患者进行测试，并将效果将与全场OK的效果进行比较。如果被证明是有效的，则可以在本地处理MDD 许多前庭治疗办公室的患者，不仅用于初始治疗，而且用于补救或随访症状恢复时的治疗。该建议还解决了VOR读取的弱点通过测试补充方法的方法。我们假设减少（习惯）速度存储能力降低对身体运动的敏感性并改善MDDS症状以及限制症状复发。我们进一步假设，对视觉刺激的脱敏可以减少视觉引起的头晕在MDDS患者中经常观察到。我们将验证这些完整的治疗方法是否会提供与重新疗法的治疗本身相比，更好的结果。最后，我们假设可以没有头部运动可以减少MDDS患者通常报告的重力拉力的错误感觉。两百人 MDDS患者将被招募进行研究。患者每天将每天治疗1-2个小时，持续5天。患者会跟进长达12个月。拟议的研究将促进通过扩大其治疗选择。