Alice in Wonderland syndrome is a complex of disorienting neurological symptoms characterized by impaired perception of body size and position, movement coordination disorder. Patients feel the body or its individual parts as larger, smaller, elongated, doubled. Sometimes the perception of time and space is distorted. Diagnosis includes examination by a neurologist, clinical conversation with a psychiatrist, brain MRI, EEG, blood tests to detect infections. Medical treatment is determined by the underlying disease.
General information
In 1955 , the British psychiatrist D. Todd described the perceptual disorders characteristic of migraines and epilepsy. Most of the disorders were associated with a change in ideas about the shape and size of the body, so the doctor called them “Alice in Wonderland syndrome” (AIWS), according to the title of L. Carroll’s fairy tale. A less common term is Todd’s syndrome.
The epidemiology of the disorder in the general population is unknown, but among patients with migraine it is about 15%. Individual symptoms are diagnosed in 30-33% of people at different periods of life. The prevalence is highest among children and adolescents.
Causes
Alice in Wonderland syndrome refers to neurological disorders. It is associated with conditions accompanied by headache, dizziness, altered consciousness. The choice of therapy depends on the causes of the syndrome, so determining the etiology is a key stage of the diagnostic process. Violations of the perception of one ‘s own body and the surrounding space may be based on:
- Migraine. Migraine headache is the most common cause of the syndrome, especially in people aged 30-40 years. Distorted perception can occur during the aura, pain attack and immediately after it.
- Organic lesions of the central nervous system. The syndrome is diagnosed in people with brain tumors, epilepsy, strokes. Organic pathology is more typical for elderly and senile patients.
- Infectious diseases. Infections affecting the nervous system are a common cause of Alice in Wonderland syndrome in childhood and adolescence. Illusions are manifested in encephalitis, the activity of the Epstein-Barr virus.
- Severe stress. Excessive physical or psycho-emotional stress can provoke single passing symptoms, for example, a feeling of swelling and enlargement of the legs. If another unfavorable factor (infection, migraine) affects, then stress becomes the trigger for a long-term disorder.
The use of psychoactive substances. Distortion of perceptual functions occurs when taking narcotic substances, abuse of psychoactive drugs. A feeling of reduction or enlargement of the body (its parts) is a common symptom of intoxication.
Pathogenesis
Alice in Wonderland syndrome has central mechanisms of origin. Perceptual disorders of various modalities (visual, tactile, proprioceptive) are caused by a decrease in the functions of brain neurons. So, in a migraine attack, due to the rapid spasm and slow relaxation of the vessel walls, various parts of the brain undergo hypoxia, and then hyperoxia, which causes disorientation, changes in perception. In other causal diseases, symptoms are provoked by traumatic, hemorrhagic, toxic damage to brain cells.
Most often damaged are those brain areas that are responsible for visual and somatosensory perception, the position of body parts in space – parietal, parietal-occipital and parietal-temporal-occipital areas. Thus, metamorphopsy (distorted body image) occurs when the cells of the parietal cortex are overexcited and the functions of the neurons of the visual region are suppressed.
The syndrome in question is not a mental disorder or an ophthalmological pathology. Violations occur at the level of the cerebral cortex, it becomes impossible to adequately process signals coming from the senses. Visual images are often distorted, less often – auditory, olfactory, tactile.
Symptoms
Alice in Wonderland syndrome occurs in episodes, their duration ranges from 5-15 seconds to 2-3 minutes. In rare cases, the attack lasts up to half an hour. During this period, the patient experiences migraine headache or discomfort in the head area. Perceptual distortions are mainly represented by micro- and biopsy. With micropsia, there is an illusion that one’s own body and/ or objects around it are narrowing, shrinking. Macropsia is a feeling of bursting, enlargement of the body, surrounding objects.
Other common symptoms are distortions in the perception of space. With pelopsia, patients see objects located in the distance as approximate. The opposite violation is teleopsy – an increase in the sense of the depth of space, as a result of which objects are perceived more distant than they actually are. The erroneous perception of the speed of the passage of time is also characteristic: a minute seems like an hour or vice versa.
In most patients, during the attack, control over the movements of the limbs decreases, coordination is disrupted. There is a feeling of numbness, heaviness, clumsiness in the whole body or in its individual parts. Skills that involve fine motor skills – writing, using a smartphone or cutlery – are deteriorating. Walking, climbing/descending the stairs becomes difficult.
Complications
With frequent episodes of AIWS, the quality of life of the patient sharply decreases. Seizures develop suddenly, so there is no way to predict their frequency and duration. Patients have to give up driving vehicles, playing sports, and professional activities. In severe cases, it becomes impossible to leave the house independently.
In children, emotional disorders can become a complication of the syndrome. If the episodes are rare and the symptoms are mild, then the child experiences them easily, like a game or an adventure. But more often, the altered perception becomes a cause of anxiety, fear, and uncertainty. Waiting for the next attack causes a state of depression and anxiety. Sleep disorders, depression, phobias develop.
Diagnostics
Alice in Wonderland syndrome is not included in the official classifications of diseases. In clinical practice, it is considered in the context of perceptual disorders provoked by a neurological or neuroinfectious disease. The examination is carried out by a neurologist, psychiatrist, ophthalmologist. The key diagnostic tasks are to establish the etiology of the syndrome, to exclude ophthalmological and psychiatric causes of the development of illusions.
At the beginning of the examination, an anamnesis is collected, the patient’s complaints are clarified, and a neurological examination is performed. The primary data make it possible to determine the need for additional examinations (clinical, physical, instrumental and laboratory). To determine the cause of the disorder , the following procedures are performed:
- MRI of the brain. Magnetic resonance imaging visualizes brain structures, blood vessels. The results allow us to detect neoplasms, acute brain disorders, the consequences of injuries and congenital defects in the structure of the organ.
- EEG. Electroencephalography registers bioelectric signals of the brain. The data obtained indicate the presence of zones of pathological activity. The main purpose of the method is to diagnose epilepsy as a possible cause of AIWS.
- Blood test. To determine the presence of infection, a general blood test is performed, as well as tests for antibodies to viruses. The final results may show the presence of viral encephalitis, Epstein-Bar virus.
Differential diagnosis requires distinguishing AIWS with psychotic disorders, inner ear pathologies, and ophthalmic diseases.
Treatment
If the symptoms of AIWS are rare and do not cause emotional discomfort, medical assistance is not required. In adolescents and children, they sometimes disappear on their own after puberty, as they grow up. For patients with frequent manifestations of the syndrome, there is no specific treatment, measures aimed at eliminating the underlying disease can reduce the symptoms.
- Antiepileptic drugs, beta-adrenergic blockers, and antidepressants are used for migraines.
- Anticonvulsants are prescribed to patients with epilepsy.
- If the cause of AIWS is an infectious disease, antiviral drugs and antibiotics are used.
Neuroleptics are ineffective, since illusions are not caused by a psychotic process. Lowering the threshold of epileptic activity with such treatment can worsen the course of the disease.
Prognosis and prevention
The search for methods of treating the syndrome continues. Currently, none of them is evaluated as highly effective, and chronic cases do not respond to therapeutic effects. The prognosis depends on the features of the course of the underlying disease. With infections, strokes, injuries, there is often a gradual reduction of symptoms (if treatment is carried out). Alice’s syndrome is a consequence of a neurological or infectious disease, so prevention is reduced to compliance with medical recommendations, regular monitoring of the dynamics of the underlying pathology (migraines, epilepsy and others).