About Vertigocatcher

Global care of people with dizziness issues does not work well today. Many patients are investigated with the wrong tests, receive the wrong diagnosis or no diagnosis at all and are referred to untargeted and ineffective treatments. This is also true in Swedish healthcare, where the sense of balance is examined sporadically or often not at all.

Analysing eye movements, known as nystagmus, is the only way to further diagnose the most common dizziness disorders.

But technology to visualise eye movements is not widely used in healthcare. Furthermore, eye movement analysis requires long experience and is perceived by many care providers as difficult. In addition, diagnostic timing is an important factor, as examinations during periods without dizziness often produce normal results.

The idea with Vertigocatcher Diagnostics is to offer a solution where those aspects of dizziness care and management that currently do not work are moved/outsourced from the general health care system.

The sense of balance examination is carried out by the patients, themselves. Analysis of the documented eye movements is transferred from general healthcare into the hands of trained specialists. If examination is carried out when symptoms are most severe, the diagnosis becomes particularly evident.

A communication platform with high standards of privacy protection compliant with GDPR connects the patient with a specialist in dizziness.

The aim is to provide timely and cost-effective dizziness care, with early diagnosis and targeted treatment being the highest priority. In addition to reducing suffering and the cost to society, this method of working should also prevent complications and long-term sick leave.

Telemedical diagnostics of balance impulses have been available for selected patients at the Yrselcenter’s dizziness clinic in Stockholm since 2017. This has been partly due to the fact that many patients live a long way from the clinic. Since 2023, the service has also been offered to other private patients. From 2024, the service will also be advertised via the dedicated website vertigocatcher.com.

The company’s first prototype for visualising eye movements using a mobile phone was CE certified in 2018 and received an EU patent in 2019. Since then, different hardware, communication systems and instructional apps have been tested with state development aid from ALMI and VINNOVA. Today, the Nystagmocatcher NC hardware is being mass-produced. Most are sold to central europe and to the netherlands. At Yrselcenter Dizzyclinic Stockholm, 30 Nystagmocatchers are available that can be borrowed for periodic monitoring of balance impulses.

One particular challenge has been to find a sufficiently privacy-protected method of transmitting medically sensitive information and to identify patients and carers.

Another challenge has been to make the patient feel sufficiently confident to be able to perform uncomfortable examinations when their world is literally spinning.

Having access to information on the balance impulses of people experiencing dizziness at all times of the day has generated a lot of new knowledge. Very little has been published so far. The biggest insights have been the understanding of how a handful of known dizziness disorders seem to be constantly changing and transitioning into each other.

Dr. Christian Geisler, specialist in hearing and balance disorders says: “Patients with the brain disorder migraine can develop a specific variant with only dizziness that does not necessarily involve headaches. This type of migraine dizziness, in turn, appears to trigger the ear disorder BPPV. A severe attack of BPPV, in turn, seems to be able to cause such a large irritation of the brain that it leads to a migraine dizziness attack. Both migraine dizziness and BPPV cause such unpleasant symptoms that they lead to non-physical functional and conditional dizziness disorders. This in turn leads to anxiety and stress. Anxiety and stress seem to trigger new migraine attacks, which in turn trigger new periods of BPPV.

Experience since 2018 shows that telemedical monitoring of balance impulses is the only way to get a structured understanding of this lottery of different dizziness disorders that constantly trigger each other. Only through patients’ own examinations when they have been experiencing obvious dizziness has it been possible to separate the different dizziness-causing illnesses from each other. Only a thorough mapping of the actual causes of dizziness will allow effective treatments to be proposed. Only then is it possible to interrupt the galloping cascade of physical and functional symptoms that many sufferers experience. Only then can healthcare costs be controlled for patients with this type of complex symptoms.”

In August 2023, the first scientific study was published in the Journal of Neurology. Sixty-two patients were examined with the Nystagmocatcher by the balance clinic at the Maastricht University Medical Center in the Netherlands.

Dizziness and balance disorders are very common symptoms and are estimated to account for one million visits to the Swedish healthcare system each year. But getting the right diagnosis and treatment can be difficult. Despite the fact that scientific studies have established that over half of all dizziness cases are due to disturbances in the sense of balance, examinations of the sense of balance in general healthcare – in so far as they are done at all – are of poor quality. Making eye movements visible and analysing their patterns is the only way to better understand the workings and disorders of the sense of balance.

However, general health care often doesn’t have the equipment to elucidate eye movements. And generally, personnel are often not used to, or experienced in, interpreting eye movements.

This is something we want to change. With a Nystagmocatcher on their mobile phone, the patient has the most important diagnostic tool for dizziness care. If the general healthcare system doesn’t examine balance disorders, there is good reason to let the patients perform the examination themselves. In addition, if the examination is performed when the symptoms are most apparent, the diagnosis will be particularly reliable.

BPPV, atypical positional dizziness, vestibular neuritis, vestibular migraine and Ménière’s disease are the most common physical dizziness disorders. All these illnesses are named diseases of the sense of balance and they all cause diagnostic eye movements during periods of strong symptoms.

Functional and conditional dizziness is another common cause. These symptoms are controlled by the amygdala in the brain and are partly psychologically related. Functional dizziness is often associated with the onset of physical dizziness but never triggers abnormal eye movements. Functional dizziness can also be part of an anxiety disorder or result from stress.

A stroke in the cerebellum or brainstem is a rare condition but has been seen in less than one per cent of all acute dizziness without concomitant neurological symptoms. Typical symptoms are a sudden onset of illness with difficulties in walking and sitting. This serious condition also causes diagnostic eye movements but should not be investigated with Nystagmocatcher. If a stroke is suspected, the person affected should immediately be taken to an emergency department for the fastest possible stroke treatment.

There are also several other physical causes of dizziness, but these causes are less common and collectively account for only 25 per cent of all cases (Brandt 1999).

To summarise, all of the physical disorders of the sense of balance will result in diagnostic eye movements if examined at the right time. However, non-physical functional dizziness disorders will never cause abnormal eye movements, such as when being examined during a panic attack.

Common balance disorders are not visible in blood tests, ECGs or X-rays. The only certain way to detect or rule out physical disorders of the sense of balance is to assess eye movements – referred to as nystagmus analysis.

The most common dizziness disorders are presented on our webbpage www.yrsel.com (swedish) including those that do not affect the sense of balance, as well as some unusual dizziness disorders.

To provide clear diagnostic eye movements, it is very important that the patients cannot control or focus their gaze. During the examination, the left eye (the eye that is not being filmed) should be closed or covered with a patch.

Dizziness is a very complex symptom. The same disorder can cause different symptoms in different people. In addition, people can suffer from several dizziness disorders at the same time, often a mixture of both physical and functional balance disorders. Further info (swedish).

Many scientific studies describe the difficulties in receiving help with dizziness from general healthcare systems. In one study, only half of dizziness patients were diagnosed at all, and of those who were diagnosed, only half felt helped (Ito 2020). In another study of patients seeking help for sudden dizziness from emergency departments, eight out of ten were misdiagnosed (Kerber 2008).