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Alice in Wonderland Syndrome

Nov 30, 2022

Alice in Wonderland syndrome (AIWS) is a rare neurological disorder characterized by distorted visual perception, alteration of body image, and an altered perception of time. These symptoms are accompanied by feelings of derealization and depersonalization. First described in 1955, the name of the condition is derived from the famous novel ‘Alice in Wonderland’ where the titular character feels her body growing larger and smaller.1,2

Changes in perception

AIWS causes a change in the sense of perception which could manifest in many ways such as:3

  • Micropsia/macropsia: objects appear smaller/larger than they are
  • Teleopsia/peleopsia: objects appear further away/closer than they are
  • Illusions of expansion, reduction or distortion of their body image in the form of micro-somatognosia (perception of shrinking body parts) or macro-somatognosia (perception of body becoming taller/larger)
  • Hallucinations involving swarm of small animals like insects or individual large animals (tigers, dogs, birds etc); this is called zoopsia
  • Changes in depth perception: example; corridors might look too long or too short.
  • Speed perception: slow movements might seem very fast; alterations such as these can cause the patient to feel overwhelmed and disoriented.
  • Sound perception: sounds may seem louder than they are, common sounds may be misinterpreted.
  • Other symptoms include loss of limb control, memory loss, persisting sound and touch sensations, etc.

AIWS has many symptoms, but they never occur simultaneously. Each symptom occurs in a 5–20-minute window. The symptoms may arise due to different causes making it difficult to pinpoint the triggers. Some of the causes that have been proposed include head trauma, migraine, infection, brain tumors, acute disseminated encephalomyelitis.4

Diagnosis

AIWS does not have any standard diagnostic criterion described in the major classification systems such as ICD-10 and DSM-5. Clinicians depend on detailed history-taking, physiological and neurological examinations (sometimes including otologic and ophthalmic examinations), and auxillary investigations (blood tests, EEG, brain MRI, etc.) if needed.1

Treatment

The condition is considered benign in most cases and full remission occurs after treatment or, in some cases, spontaneously. However, in cases where an underlying chronic condition is present (such as migraine or epilepsy), symptoms can recur based on the status of the underlying condition and treatment needs to be designed with the aim of resolving/controlling it via antiepileptics, migraine prophylaxes, antiviral agents, etc.1,3

Conclusion

A bizarre amalgamation of hallucinations and altered perception of space and time, AIWS is a neurological condition that has so far not received the attention it deserves in the medical community. Including it in standardized treatment guidelines will go a long way in addressing this condition and improve treatment modalities.

References

  1. Blom JD. Alice in Wonderland syndrome: A systematic review. Neurol Clin Pract. 2016 Jun;6(3):259–70.
  2. Naarden T, ter Meulen BC, van der Weele SI, Blom JD. Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease. Front Neurol. 2019 May 9;10:473.
  3. Farooq O, Fine EJ. Alice in Wonderland Syndrome: A Historical and Medical Review. Pediatr Neurol. 2017 Dec;77:5–11.
  4. Alice in Wonderland Syndrome | Symptoms & Treatment [Internet]. UPMC HealthBeat. 2016 [cited 2022 Aug 24]. Available from: https://share.upmc.com/2016/10/alice-in-wonderland-syndrome/

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