Mal de Débarquement Syndrome (MdDS): A Functional Neurology Perspective

At Delta Neuro Health, we frequently work with patients who have been told “everything looks normal”, yet they continue to feel anything but normal. One condition that fits this pattern all too well is Mal de Débarquement Syndrome (MdDS).

MdDS is a neurologic disorder characterized by a persistent sensation of rocking, swaying, or bobbing after exposure to passive motion, such as a cruise, flight, or long car ride. Unlike typical motion sickness or inner ear disorders, MdDS is a central nervous system adaptation problem, not a structural one. Understanding this distinction is key to effective care.

Understanding the Pathophysiology of MdDS

MdDS is best explained as a failure of the brain to appropriately readapt after prolonged motion exposure.

A Brain Stuck in “Motion Mode”

During passive motion (like being on a boat), the brain adapts by recalibrating vestibular reflexes to maintain stability. When that motion stops, the nervous system should smoothly transition back to baseline.

In MdDS, that transition does not occur.

Instead:

• Motion-processing networks remain persistently active

• The brain continues to perceive movement even in stillness

• Patients often feel better while driving and worse at rest, a hallmark feature of MdDS

This tells us the problem is not ongoing motion, it is how the brain is interpreting sensory input.

Vestibulo-Cerebellar Involvement

Current research points toward dysfunction within the vestibulo-cerebellar network, particularly areas responsible for:

• Motion adaptation

• Velocity storage

• Integration of vestibular, visual, and proprioceptive input

The cerebellum plays a critical role in predicting and canceling out repetitive motion. When this system becomes maladapted, motion signals are not properly suppressed once the stimulus is removed.

At Delta Neuro Health, we evaluate how these systems are functioning in real time, rather than relying solely on imaging or standard vestibular testing, which is often normal in MdDS.

Maladaptive Neuroplasticity

MdDS is a classic example of neuroplasticity working in the wrong direction.

Instead of updating sensory information efficiently, the brain becomes “locked” into a prior motion pattern. Over time, this can affect:

• Postural tone

• Gait mechanics

• Visual dependence

• Autonomic regulation

This explains why many individuals with MdDS also experience fatigue, brain fog, anxiety, and difficulty in visually busy environments.

Who Is Most Commonly Affected?

MdDS has a surprisingly consistent demographic pattern:

• Approximately 80–90% of cases occur in women

• Most commonly affects individuals between 30 and 60 years old

• Frequently follows:

  • Cruises

  • Long flights

  • Extended car or train travel

• In some cases, symptoms arise spontaneously, without a clear motion trigger

Despite the severity of symptoms, routine testing is often unremarkable, leading to frustration, delayed diagnosis, and a sense of being dismissed.

How Functional Neurology at Delta Neuro Health Addresses MdDS

Because MdDS is a central processing disorder, it requires a brain-based approach. At Delta Neuro Health, we focus on identifying which neurologic networks are not adapting appropriately, and then applying targeted inputs to drive healthier plasticity.

Precision Vestibular Rehabilitation

Rather than generic balance exercises, we use:

• Direction-specific vestibular stimulation

• Controlled exposure to motion patterns

• Exercises designed to normalize velocity storage and motion perception

The goal is to help the brain relearn when motion has truly stopped.

Cerebellar and Eye–Head Coordination Training

Given the cerebellum’s role in MdDS, care often includes:

• Gaze stabilization with graded cerebellar loading

• Eye–head coordination tasks

• Rhythm and timing-based movement challenges

These interventions are chosen based on how each patient’s nervous system responds, not a one-size-fits-all protocol.

Gait, Posture, and Sensory Integration

At Delta Neuro Health, gait and posture are not afterthoughts—they are windows into neurologic function.

We assess and retrain:

• Subtle asymmetries in gait and weight shift

• Visual-vestibular-proprioceptive integration

• Ground reaction force and postural tone

This helps reduce the constant “background noise” of perceived motion.

Autonomic and Limbic Regulation

Many individuals with MdDS also show signs of autonomic imbalance, including:

• Heightened sympathetic tone

• Difficulty downregulating after stimulation

• Increased symptom awareness under stress

We incorporate strategies to improve autonomic flexibility, often using:

• Breathing-based neurologic regulation

• Heart rate variability–guided interventions

• Gradual desensitization of threat-based neural circuits

This helps calm the nervous system while retraining motion perception.

A Different Way Forward

MdDS is not progressive, and it is not “all in your head”, but it is in the brain. When care is focused on restoring appropriate sensory integration and neuroplastic balance, meaningful improvement is possible.

At Delta Neuro Health, our goal is not simply to manage symptoms, but to help the nervous system re-establish stability, adaptability, and confidence in movement.

If you’ve been told to “just wait it out” or that your testing is normal despite ongoing symptoms, a comprehensive functional neurologic evaluation may provide answers and a path forward.

Take the Next Step

If you or someone you care for is experiencing persistent rocking, swaying, or motion sensations after travel, and standard testing has not provided clear answers, there may be an opportunity to look deeper at how the nervous system is processing motion and balance.

At Delta Neuro Health, we offer comprehensive functional neurologic evaluations focused on vestibular, cerebellar, gait, and autonomic function to better understand why symptoms are persisting and how to address them.

To learn more or to schedule an evaluation, visit www.deltaneurohealth.com or contact our office directly at (614) 706-2093. For many patients, the most important step forward is simply finding a framework that finally makes sense of their symptoms.