Alice in Wonderland Syndrome: When Reality Feels Like a Fairytale

 

 INTRODUCTION:

                                  Alice in Wonderland Syndrome (AIWS) is an unusual disorder presenting perceptual disturbances of visual space body schema and time. This syndrome owes its name from the famous story book Alice's Adventures in Wonderland by Lewis Carroll and has originated by the primary description given by John Todd in 1955. 

With this syndrome, a visceral change in the way they see their body leads to wrong impressions about size, space, and time. For instance, things could appear smaller (micropsia) or larger (macropsia) than they actually are, while a person might perceive his body parts to be of an abnormal shape.

AIWS has diverse origins in migraine, infection, epilepsy, and brain trauma. While a constellation of its symptoms can seem odd to an outsider, they are often missed by physicians since it's rare and there are no established diagnostic tests.    

THE SCIENCE BEHIND PERCEPTION DISTORTIONS:

The temporo-parietal-occipital crossroad of the brain is responsible for the overall integration of sensory input with the construction of body schema. Disruption in this area, as indicated by neuroimaging studies, is popularly linked with the symptoms of AIWS. For example:

Visual Distortions: Micropsia and macropsia accompany. Hyperactivation or hypoactivation of occipital and parietal lobes.

Somatosensory Illusions: Distortions of the body arise from abnormal processing in sensory association areas.

Time and Space Perception: Altered integration in the thalamus and related networks may explain temporal distortions.

EPIDEMIOLOGY:

AIWS affects largely children and adolescents with peak incidence ages 5-14. The exact prevalence is unknown but is commonly associated with migraine and viral infection. Studies indicated that a high proportion of individuals with AIWS symptoms have a first-degree family history of migraines, indicating that migraine has a strong genetic linkage. 

 DIAGNOSIS AND MANAGEMENT:

                                                               A multi-faceted approach is required to diagnose Alice in Wonderland Syndrome: full history, clinical, and neurological examination, as well as further investigations such as EEG and MRI to differentiate them from hallucinations, illusions, and other perceptual disturbances. This is accomplished through identifying underlying causes of AIWS, many of which are migraines or infections. In most cases, AIWS is benign and resolves spontaneously without any therapy; treatments are geared toward correcting the underlying pathologies, including antiviral agents for infections or migraine prophylaxes. In chronic situations, these patients will probably require long-term reassurance and caretaking. Some challenges in the assessment of AIWS arise from the varied presentations, but progress in neuroimaging and functional studies gives great insights into understanding the pathophysiology. Raising awareness and creating some minimum baseline criteria for diagnosis would certainly help in improving management and outcomes.

TREATMENT:

Treatment aims to treat the underlying cause: Migraine with Associated AIWS: Migraine prophylactics such as beta-blockers, antiepileptics, or antidepressants. Infection-Induced AIWS: Antiviral or antibiotic therapy in conjunction with supportive care. Epileptic AIWS: Antiepileptic medications such as valproate or levetiracetam. Psychiatric AIWS: psychotherapeutic or psychopharmacological treatment on the basis of the condition in question.

REFERENCES:

• Mastria, G., Mancini, V., Viganò, A., & Di Piero, V. (2016). Alice in Wonderland Syndrome: A Clinical and Pathophysiological review. BioMed Research International, 2016, 1–10. https://doi.org/10.1155/2016/8243145
• Blom, J. D. (2016). Alice in Wonderland syndrome: A systematic review. Neurology: Clinical Practice, 259–270.

IMAGE SOURCE:

• https://images.app.goo.gl/VZfVfA7a1rHEJBDb7

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