Timothy C. Hain, MD • Page last modified: November 1, 2022
Authors of study |
Median Duration (mo.) |
Cha et al, 2008 |
Variable, only 20% remaining after 10 months |
Brown and Baloh, 1987 |
4 mo |
Murphy, 1993 |
1-12 mo |
Mair, 1996 |
1-6 mo |
MdDS often ends by itself, typically within 4 months (median duration according to Cha et al, 2008). There are also some medications to suppress rocking or to speed up resolution of the symptoms. TMS treatment (magnetic) discussed here seems to have a very low rate of benefit (Canceri et al, 2018), but recent studies have suggested a better response (Cha et al, 2022).
Dr. Yoon Cha, has pioneered this research effort. (Cha et al, 2012, 2013, 2016, 2021, 2022; Chen et al 2021). These studies are all from the same group. The idea here is that by using magnetic or electrical fields to temporarily change the electrical activity of the brain, MdDS might be alleviated.
Our understanding of this effort is that although sometimes positive effects are elicited, they are temporary. According to Cancieri et al (2018), in their survey study, only about 6.3% of MdDS patients benefitted from TMS. This was approximately the same percentage that benefitted from osteopathy, and far less than the 56% reported to benefit from medication (i.e. either benzodiazepines or SSRI/SNRI). In a double blind randomized trial, Cha et al (2022) reported " Compared to baseline, 10/24 completers noted >/= 25% reduction, 5/24 >/=50% reduction, and 2/24 >/=75% reduction in oscillating vertigo intensity. ... Fronto-occipital tACS may be effective in reducing the oscillating vertigo of MdDS and serve as a portable neuromodulation alternative for longer-term treatment. " . Hm. Perhaps the treatment has gotten better.
Practically, to try this treatment, one has to visit Dr. Cha (presently in Minnesota), and participate in a research study.
Older studies: Repetitive transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex was reported by Cha to be associated with “short-term symptom improvement”, in a pilot study of Cha in 2013 as well as helpful in 5 of 10 subjects in more recent studies of Guofa et al (2015) and Pearce (2015). More study is needed of this treatment modality for MdDS. In TMS, generally any changes are temporary. For example, although TMS can be used to treat depression, one needs to do it over and over again every week.
Cha and co-workers have also trialed electrical stimulation protocols involving alternating current and Cerebellar/occipital "theta burst". These treatments are currently provided as part of research protocols, and are not in regular use.
Chen et al (co-authored with Cha) wrote in 2021 "Using electrophysiological source imaging and a data-driven method, we identified network-level connectivity changes in EEG that correlated with symptom responses after completion of multiple sessions of cTBS. We further determined that connectivity changes demonstrated by EEG during test sessions of single administrations of cTBS were signatures that could predict optimal targets." In other words, changes in EEG associated with "continuous theta burst" treatment (a variant of TMS), help identify targets. This makes some sense, but doesn't tell us if this treatment is a good one.
Dai et al (2017) commented that "Since the process producing the MdDS most likely originates in the velocity storage mechanism in the brainstem, magnetic cortical stimulation is likely to be ineffective in producing long-term relief." Our perspective on this comment is that in reality, we don't think the "process producing the MdDS" has been clearly identified, but given that in TMS changes are generally temporary, the timing comment is likely correct.
Rather than stimulating the brain, how about stimulating the inner ear ?
Motion often improves MdDS (such as driving or riding in a car). There are several devices now sold commercially that create an illusion of motion by passing electrical current through the inner ear. Examples are:
Neursantys -- offers a wearable device that appears to be designed for patient use.
Soterixmedical -- offers a device that appears to be designed for clinical use
We are investigating these devices, but have no patient data as yet. .