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What is the difference between MdDS and PPPD?

MdDS is triggered by exposure to passive motion, whereas PPPD is triggered by events that disrupt balance function.



Mal de Débarquement Syndrome (MdDS) and Persistent Postural-Perceptual Dizziness (PPPD) are both chronic vestibular disorders, but they differ primarily in their triggers and symptom behavior. MdDS is typically triggered by a period of passive motion, such as a cruise, flight, or long car ride; once the person returns to "solid ground," they feel a persistent sensation of rocking, bobbing, or swaying. Uniquely, MdDS symptoms often improve when the person is back in motion (e.g., driving a car). In contrast, PPPD is often triggered by a discrete vestibular event (like vertigo) or high stress, and its symptoms—usually a persistent sense of unsteadiness or "heavy-headedness"—are typically worsened by motion, upright posture, or complex visual environments. While both conditions involve a brain that is struggling to re-calibrate its sense of balance, MdDS is a failure to "readapt" to stillness after motion, whereas PPPD is a state of "hyper-awareness" and over-reliance on visual cues following a balance system disruption.

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MdDS is different for each patient, so walking on beach is OK for some but not for others. Avoid virtual reality and driving simulator experiences. If you are still experiencing symptoms, it is recommended not to walk on a treadmill and to use an elliptical machine.

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In addition, individuals with MdDS have high comorbidities with migraine, increased visual sensitivity, and mood disorders, e.g., depression and anxiety (1, 2). The association with stress should also be further investigated, since it is known that stress can exacerbate MdDS symptoms (18).

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In some cases, MdDS resolves on its own within a year. Prevention and symptom management for MdDS includes stress management, regular exercise, healthy eating, and rest. Clonazepam is an anti-seizure drug that is sometimes effective at low doses in treating symptoms of MdDS.

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