Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Occipital and Cerebellar Theta Burst Stimulation for Mal De Debarquement Syndrome

Cha, Yoon-Hee*,†; Gleghorn, Diamond*; Doudican, Benjamin*

doi: 10.1097/MAO.0000000000002341

Background: Individuals with Mal de Debarquement syndrome (MdDS) experience persistent oscillating vertigo lasting for months or years. Transcranial magnetic stimulation (TMS) can modulate the motion perception of MdDS.

Materials and Methods: Twenty-six TMS naive individuals received single administrations of continuous theta burst stimulation (cTBS) over the occipital cortex, cerebellar vermis, and lateral cerebellar hemisphere, in randomized order. A 0–100 point Visual Analogue Scale was used to assess acute changes in oscillating vertigo severity after each session. Repeated treatments were given over the target that led to the most acute reduction in symptoms. All treatments were performed with neuronavigation using the participant's own brain MRI. The Dizziness Handicap Inventory (DHI), MdDS Balance Rating Scale (MBRS), and Hospital Anxiety and Depression Scale (HADS) were assessed weekly at four pretreatment and six posttreatment time points.

Results: Twenty participants chose either the occipital cortex (11) or cerebellar vermis (9) targets as most effective in reducing the oscillating vertigo; one chose lateral cerebellar hemisphere; five chose none. After 10 to 12 sessions of 1,200 pulses over the target of choice, 19 of 25 treatment completers noted ≥ 25% reduction, 12 of 25 ≥50% reduction, and 8 of 25 ≥75% reduction in oscillating vertigo intensity. A one-way repeated measures ANOVA of DHI, MBRS, and HADS scores before and after treatment showed significant reductions in DHI, MBRS, and the HADS Anxiety subscore immediately after treatment with most improvement lasting through posttreatment week 6. There were no significant Depression subscore changes. Participants who had chosen vermis stimulation had comparatively worse balance at baseline than those who had chosen occipital cortex stimulation.

Conclusion: cTBS over either the occipital cortex or cerebellar vermis is effective in reducing the oscillating vertigo of MdDS acutely and may confer long-term benefits. Sustained improvement requires more frequent treatments.

*Laureate Institute for Brain Research

University of Tulsa, Tulsa, Oklahoma

Address correspondence and reprint requests to Yoon-Hee Cha, M.D., 6655 South Yale Avenue, Tulsa, OK 74136; E-mail:

This work was supported by the Laureate Institute for Brain Research, the William K. Warren Foundation, an equipment and study grant from the MdDS Balance Disorders Foundation, the Springbank Foundation, an award through NSF EPSCoR RII Track-2 #1539068, and NIH/NIGMS grant P20 GM121312.

All authors were involved in the design, data collection, analysis, and manuscript preparation.

The authors disclose no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company