Double-blind randomized N-of-1 trial of transcranial alternating current stimulation for mal de débarquement syndrome

• Published in: PloS one 2022-02, Vol.17 (2), p.e0263558
• Main Authors: Cha, Yoon-Hee, Gleghorn, Diamond, Doudican, Benjamin Chipper
• Format: Article
• Language: English
• Subjects: Achievement tests; Adult; Aged; Air transportation; Aircraft; Alternating current; Assessments; Biology and Life Sciences; Brain research; Brain stimulation; Care and treatment; Double-Blind Method; Double-blind studies; Electrical stimuli; Entrainment; Female; Frequency control; Frontal Lobe - physiopathology; Health aspects; Humans; Male; Medicine and Health Sciences; Methods; Middle Aged; Motion Sickness - therapy; Nervous system diseases; Neuromodulation; Occipital Lobe - physiopathology; Oscillometry; Physiological aspects; Psychological aspects; Reduction; Research and Analysis Methods; Side effects; Stimulation; Testing; Transcranial Direct Current Stimulation - methods; Travel-Related Illness; Variance analysis; Vertigo
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0263558

Mal de Débarquement Syndrome (MdDS) is a medically refractory neurotological disorder characterized by persistent oscillating vertigo that follows a period of entrainment to oscillating motion such as experienced during sea or air travel. Fronto-occipital hypersynchrony may correlate with MdDS symptom severity. Individuals with treatment refractory MdDS lasting at least 6 months received single administrations of three fronto-occipital transcranial alternating current stimulation (tACS) protocols in an "n-of-1" double-blind randomized design: alpha frequency anti-phase, alpha-frequency in-phase, and gamma frequency control. Baseline assessments were made on Day 1. The treatment protocol that led to the most acute reduction in symptoms during a test session on Day 2 was administered for 10-12 stacked sessions given on Days 3 through 5 (20-minutes at 2-4mA). Pre to post symptom changes were assessed on Day 1 and Day 5. Participants who could clearly choose a preferred protocol on Day 2 did better on Day 5 than those who could not make a short-term determination on Day 2 and either chose a protocol based on minimized side effects or were randomized to one of the three protocols. In addition, weekly symptom assessments were made for four baseline and seven post stimulation points for the Dizziness Handicap Inventory (DHI), MdDS Balance Rating Scale (MBRS), and Hospital Anxiety and Depression Scale (HADS). Of 24 participants, 13 chose anti-phase, 7 chose in-phase, and 4 chose control stimulation. Compared to baseline, 10/24 completers noted ≥ 25% reduction, 5/24 ≥50% reduction, and 2/24 ≥75% reduction in oscillating vertigo intensity from Day 1 to Day 5. Stimulating at a frequency slightly higher than the individual alpha frequency (IAF) was better than stimulating at exactly the IAF, and slightly better than stimulating with a strategy of standardized stimulation at 10Hz. A one-way repeated measures ANOVA of weekly DHI, MBRS, and HADS measurements showed significant reductions immediately after treatment with improvement increasing through post-treatment week 6. Fronto-occipital tACS may be effective in reducing the oscillating vertigo of MdDS and serve as a portable neuromodulation alternative for longer-term treatment. Stimulation frequency relative to the IAF may be important in determining the optimum treatment protocol [ClinicalTrials.gov study NCT02540616. https://clinicaltrials.gov/ct2/show/NCT02540616].