Mal de Debarquement Syndrome (MdDS) is an enigmatic neurotological disorder with 
high morbidity, psychosocial burden, and few treatment options. Fortunately, 
there has been recent growth in scientific interest in understanding the 
biological basis of and in treating MdDS. Recent studies using functional 
neuroimaging have shown increased glucose metabolism in the left entorhinal 
cortex (EC) and amygdala in the setting of decreased prefrontal and temporal 
cortex metabolism in subjects with persistent MdDS. The EC is a key player in 
processing and gating spatial information to be stored in the hippocampus and is 
a major driver of brain oscillations. A limbic focus may also be key to 
spontaneous MdDS-like symptoms occurring in individuals with a history of 
anxiety or chronic stress. Treatment with repetitive transcranial magnetic 
stimulation over the dorsolateral prefrontal cortex can decrease the rocking 
dizziness of MdDS, with successful responses associated with decreases in the 
coherence between brain networks with nodes in the parietal and occipital lobes. 
A new theory of MdDS is proposed as pathology secondary to entrainment of 
intrinsic brain networks driven by oscillatory motion exposure coupled with an 
inability to subsequently desynchronize the activity of these nodes. Future 
treatment strategies may be directed toward unyoking these networks.