Can anemia contribute to or exacerbate symptoms of mal de debarquement?

Anemia is Not a Known Cause of Mal de Debarquement Syndrome

Anemia is not recognized as a cause or contributor to Mal de Debarquement Syndrome (MdDS) symptoms based on current medical evidence. MdDS is a neurological disorder characterized by a persistent sensation of rocking, swaying, or bobbing that typically occurs after exposure to passive motion, most commonly after sea travel.

Understanding Mal de Debarquement Syndrome

MdDS has specific characteristics that distinguish it from other conditions:

• Primary symptoms: Persistent sensation of rocking, swaying, or bobbing 1, 2
• Onset pattern: Usually begins immediately following exposure to passive motion (typically sea travel) 1
• Demographics: Approximately 80% of sufferers are women, most commonly middle-aged 1
• Unique feature: Unlike other vestibular disorders, symptoms typically improve with re-exposure to motion 1
• Duration: Symptoms persist for a month or longer (distinguishing it from temporary land-sickness) 2

Pathophysiology of MdDS

Current understanding of MdDS points to neurological mechanisms rather than hematological ones:

• The condition likely originates in the vestibular system 3
• Current hypotheses suggest cerebral and cerebellar involvement 4
• Vestibulo-ocular reflex (VOR) maladaptation appears to play a significant role 5

Treatment Approaches for MdDS

Effective treatments for MdDS focus on neurological mechanisms:

• VOR readaptation therapy using optokinetic stimulation paired with head movements has shown a success rate of approximately 64% 5
• Benzodiazepines may provide some relief but have limited usefulness due to addiction potential 1
• Visual habituation exercises and transcranial magnetic stimulation are being investigated 1, 4
• Common vestibular suppressants are generally ineffective 1

Anemia and Its Symptoms

While anemia can cause various symptoms, they differ significantly from the characteristic presentation of MdDS:

• Anemia symptoms: Fatigue, weakness, dizziness, shortness of breath, headaches, cold extremities 6
• MdDS symptoms: Persistent rocking/swaying sensation, improved with re-exposure to motion 1

Anemia-related dizziness typically presents as lightheadedness or vertigo that worsens with position changes or exertion, rather than the constant rocking sensation characteristic of MdDS 6.

Important Clinical Considerations

If a patient presents with both MdDS symptoms and anemia:

1. Treat them as separate conditions: The anemia should be evaluated and treated according to standard protocols 6
2. Consider symptom overlap: Fatigue and cognitive difficulties can occur in both conditions 6, 4
3. Evaluate for underlying causes: Both conditions could potentially stem from a third undiagnosed issue

Conclusion

When evaluating patients with symptoms suggestive of MdDS who also have anemia, clinicians should:

1. Address the MdDS through appropriate neurological interventions
2. Separately investigate and treat the anemia according to its specific cause
3. Recognize that treating the anemia is unlikely to resolve the MdDS symptoms

The most effective approach for MdDS remains VOR readaptation therapy, with a standardized protocol showing benefit in approximately two-thirds of patients regardless of onset type 5.