Mal de Débarquement Syndrome (MdDS) is a condition where a person feels continuous swaying, rocking, or bobbing, typically after travelling on a boat or ship. Mild symptoms lasting 24–48 hours after a sea trip are extremely common among sailors (about 73%)¹.
For some people, however, these sensations do not go away and can last for weeks, months, or even longer.
A typical feature of MdDS is that symptoms often improve while riding in a car or travelling on water, but return once the movement stops.
If you experience rocking only during physical activity, it is probably not MdDS, as activity-related rocking is a common symptom in many other vestibular conditions.
Types of MdDS
For many years, doctors thought MdDS was always caused by travel. We now know that other vestibular disorders—such as BPPV or vestibular migraine—can also trigger MdDS.
This means there are two main forms:
1. Motion-Triggered MdDS (MT-MdDS)
Triggered by boat or ship travel.
Typical features:
- Slow rocking sensation around 0.2 ± 0.1 Hz (similar to large ocean waves)²
- Symptoms improve during passive motion (car, train, boat)
2. Non-Motion-Triggered MdDS (Non-MT MdDS)
Triggered by another vestibular disorder or with no clear cause.
Typical features (clinical observations):
- Rocking sensation with higher or variable frequency, not wave-like
- Often accompanied by sensitivity to head movements, visual motion intolerance, and sometimes anxiety
Treatment Options
The Original “Dai Treatment” (Optokinetic Therapy)
The first structured treatment was developed in the US and described by Dai et al. in 2014².
How it worked:
Patients sat in a circular room with rotating black-and-white stripes.
During treatment:
- Stripes rotated at a constant speed
- The examiner gently rocked the patient’s head (±20°) at the patient’s own rocking frequency
- Each session lasted 3–5 minutes
- Patients received 1–8 sessions per day for up to 5 days
Results:
- About 70% experienced long-term improvement
- Follow-up ranged from 4 months to 2.5 years (average 11.6 months)
The challenge: very few clinics can build a circular room like the original US setup. Attempts using TVs, iPads, projectors, or improvised rotating environments have produced mixed results.
New Technology: Virtual Reality Treatment
A recent development from a team in Antwerp, Belgium, has made it possible to reproduce the same treatment using **Virtual Reality (VR)**³.
They created an application (first for Android phones, later for Meta Quest VR systems) that displays full-field moving stripes, similar to those used in the Dai treatment.
How the VR treatment works:
- Same type of stripes (13 visible)
- Same stripe speed (10°/s)
- Head rocking ±20°
- Rocking frequency fixed at 6-second intervals
- Two sessions per day for 4 days, each lasting 4 minutes
Research Results
In a randomized controlled trial, the Antwerp team compared:
- VR-based treatment (15 patients)
vs. - Original circular-room treatment (15 patients)
Results showed the treatments were equally effective.
Patients reported an average symptom reduction of 1.92 ± 0.42 on the VAS scale (1–10).
If You Think You Might Have MdDS
- Rule out other vestibular conditions.
See a specialist. This is especially important if your rocking sensation worsens with activity or if you may have Non-MT MdDS. - Avoid benzodiazepines.
Although some online sources recommend them, these medications can be highly addictive and often worsen MdDS symptoms over time. - Consider VR-based treatment.
Our clinic collaborates with the Antwerp MdDS team.
If you purchase their VR software license, we can guide you through the treatment:- Fully in our clinic
- At home
- Or a combination of both over a 4-day period
- A modern Android smartphone, or
- A Meta Quest VR system
References
- Gordon CR, Spitzer O, Shupak A, Doweck I. Survey of mal de debarquement. BMJ. 1992;304:544.
- Dai M, Cohen B, Cho C, Shin S. Treatment of the mal de débarquement syndrome: a 1-year follow-up. Front Neurol. 2014.
- Schoenmaekers et al. Virtual reality–based treatment for MdDS. 2024.