Double-Blind Sham-Controlled Crossover Trial of Repetitive Transcranial Magnetic Stimulation for Mal de Debarquement Syndrome.

OBJECTIVE: To determine whether the chronic rocking dizziness that occurs in Mal de Debarquement Syndrome (MdDS) can be suppressed with repetitive transcranial magnetic stimulation (rTMS) beyond the treatment period.

METHODS: We performed a prospective randomized double-blind sham controlled crossover trial of 5-days of rTMS utilizing high frequency (10 Hz) stimulation over the left dorsolateral prefrontal cortex (DLPFC).

RESULTS: Eight right-handed women (44.5 [SD 7.0] yr) with classical motion-triggered MdDS (mean duration 42.1 [SD 13.2] mo) participated. Group level mixed effects repeated measures analysis of variance (ANOVA) showed improvement in our primary outcome measure, the Dizziness Handicap Inventory (DHI) at Post TMS Weeks 1, 3, and 4 (p < 0.05) and a trend at Week 2 (p = 0.089) after Real rTMS. On the Hospital Anxiety and Depression Scale (HADS), improvements started at Post TMS Week 2 for the Anxiety subscore and Post TMS Week 3 for the Depression subscore after Real rTMS only (p < 0.05). There were no group level improvements on the MdDS Balance Rating Scale (MBRS) after Real rTMS though there were three participants who improved on an individual level. There were no significant group level changes after Sham stimulation on any measure.

CONCLUSION: Our study provides evidence that the dizziness, mood and anxiety symptoms of MdDS can be improved with 10 Hz rTMS over left DLPFC beyond the treatment period in selected individuals. rTMS may be a useful adjunctive treatment for the management of chronic rocking dizziness in individuals with MdDS but treatment durations longer than 5 days or maintenance treatment are likely needed for sustained symptom suppression.