OBJECTIVE: Mal de debarquement syndrome (MdDS) is a chronic disorder of 
imbalance characterized by a feeling of rocking and swaying. The disorder starts 
after prolonged exposure to passive motion such as from a boat or plane. All 
medical treatment is palliative and symptoms that persist beyond 6 months show 
low likelihood of remission. This pilot study explored the feasibility and 
tolerability of repetitive transcranial magnetic stimulation (rTMS) as potential 
treatment for MdDS.
PATIENTS/INTERVENTION: Ten subjects (8 women) with persistent MdDS lasting from 
10 to 91 months were given 1 session each of 4 counterbalanced protocols: left 
10 Hz (high frequency), left 1 Hz (low frequency), right 10 Hz, and right 1 Hz 
rTMS over the dorsolateral prefrontal cortex (DLPFC).
MAIN OUTCOME MEASURE: Reduction of rocking sensation reported on a visual 
analogue scale.
RESULTS: 1) Right-handers improved most with 10-Hz stimulation over the left 
DLPFC while left-handers improved most with 10 Hz stimulation over the right 
DLPFC; 2) low-frequency DLPFC stimulation was associated with symptom worsening 
in some subjects; 3) duration of symptoms was negatively correlated with 
treatment response; 4) rTMS was well tolerated in MdDS subjects, showing similar 
rates of headache (10 of 40 sessions) as for other studies; and 5) fatigue 
occurred after 6 sessions usually with low-frequency stimulation.
CONCLUSION: rTMS was well tolerated in subjects with MdDS with promising 
short-term symptom improvement. Future studies of rTMS in MdDS may consider 
sequential days of stimulation, longer post-rTMS observation periods, formal 
measurement of post-TMS fatigue, and randomization with a sham condition.