Alice in Wonderland syndrome refers to a neurological symptom complex associated with impaired perception of the environment and/or self. Migraine and epilepsy patients and young children are most commonly affected by Alice in Wonderland syndrome.
What is Alice in Wonderland syndrome?
Alice in Wonderland syndrome refers to a neurological symptom complex associated with impaired perception of the environment and/or self. Alice in Wonderland syndrome refers to a distorted perception of the environment and/or the self, which in most cases can be attributed to various underlying diseases such as migraine, epilepsy, infections with certain viruses (Epstein-Barr virus) or drug abuse. An Alice in Wonderland syndrome, which is not considered a disease in its own right, is usually manifested by metamorphopsia, in which objects are perceived as enlarged (macropsia) or reduced (micropsia), more distant (teleopsia, porropsia) or closer (pelopsia), distorted, deformed, spatially misaligned (mirror-inverted, upside-down), or color-modified. In addition, an Alice in Wonderland syndrome can manifest itself through ego experience disorders (depersonalization, splitting of soul and body), a disturbed sense of time, ashematisms (disturbances of the body schema) as well as floating sensations and disturbances of the sense of hearing and tact. Anxiety and panic states, marked fatigue and headaches, dizziness, vomiting, and nausea may be other symptoms of Alice in Wonderland syndrome.
Causes
The causes of Alice in Wonderland syndrome have not yet been fully determined. Based on the characteristic symptoms, the syndrome is thought to be triggered by organic and/or functional abnormalities of the temporal lobe (lobus temporalis), which includes the primary auditory cortex, the sensory language center (Wernicke’s center), visual working memory, and neocortical associative areas (processing of complex nonspatial auditory and visual stimuli). Lesions in this area, particularly the associative temporal cortex, can lead to various auditory and visual deficits (agnosias) such as objectagnosia, prosopagnosia (face blindness), amusias (impaired perception of sounds), or aphasias (speech disorders). In addition, epilepsy is associated with temporal lobe disorders (temporal lobe epilepsy). In addition to epileptic seizures, Alice in Wonderland syndrome occurs in association with migraine, viral infections (Epstein-Barr virus), drug abuse (substance abuse), and in the phases between wakefulness and sleep (hypnagogic and hypnopompic states).
Symptoms, complaints, and signs
An Alice in Wonderland syndrome is initially manifested by acute or gradual changes in the perception of one’s environment. This is usually accompanied by accompanying symptoms such as fatigue and exhaustion or headaches. Often, affected individuals feel confused or suffer from an indefinable anxiety. Hallucinations and hypersensitivity to light and sound may also occur. Some affected individuals have an altered sense of time or an unusual sense of touch for a short or long period of time. Typical is the feeling that everything is perceived reduced in size or enlarged. This micropsia or macropsia often leads to dizziness and gait disturbances – the affected persons can no longer find their way around in their familiar surroundings. If severe, it can lead to neurological deficits. The child then perceives “fantastic images” or suffers epileptic seizures. The symptoms usually occur in childhood, but can continue into adulthood and possibly persist throughout life. It is especially common to experience unusual sensations and physical or mental discomfort during periods of falling asleep and waking up. The stress this causes can lead to accompanying symptoms such as abdominal pain, migraines, sleep disturbances, depression, and personality changes.
Diagnosis and course
Alice in Wonderland syndrome is diagnosed on the basis of the symptoms described by the affected person in the medical history, particularly the perceptual disturbances characteristic of the syndrome.In this case, an Alice in Wonderland syndrome can be assumed if possible other physiological impairments besides the typical underlying diseases for the manifestation of the syndrome can be excluded. Differential diagnosis should determine the specific disorder causing the syndrome (migraine, epilepsy, or viral infection). While diagnostic imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), EEG, or Doppler sonography can provide information about underlying epilepsy or migraine, viral infectious diseases (Epstein-Barr virus) are detected by blood analysis. Alice in Wonderland syndrome is often diagnosed in childhood. Although in many cases the syndrome resolves on its own during puberty, some affected individuals are affected by Alice in Wonderland syndrome for life, especially during the periods of falling asleep and waking up.
Complications
Alice in Wonderland syndrome often occurs in children who may suffer from social problems because of the symptoms. Other children may be frightened by the syndrome and withdraw from the affected child. They may also react with ridicule and gloating, which can extend to bullying. The stress this causes can lead to additional complications for the affected child – for example, worsening general health, abdominal pain, headaches, or psychological disorders such as anxiety disorders, depression, and sleep disturbances. Adults can also suffer from the social and psychological complications of the syndrome. The orientation disorders that occur as part of Alice in Wonderland syndrome can cause both children and adults to get lost or lost. Adolescents and adults may be suspected of alcohol or drug use in some cases. The orientation disorders can lead to limitations in daily living. For example, if an acute episode occurs on the way to an important appointment, the person may be late or become so disoriented that he or she later does not remember how he or she got to a place. The chronic form of Alice in Wonderland syndrome, in particular, can also result in widespread lifestyle limitations. Other complications may also occur and depend primarily on the underlying disease responsible for the syndrome.
When should you see a doctor?
If Alice in Wonderland syndrome is suspected, a doctor must clarify the cause and treat it if necessary. Medical advice is especially needed if there are frequent misperceptions that cannot be attributed to any specific cause and that limit the affected person in everyday life. If these perceptual changes and hallucinations have a negative effect on the general well-being, a doctor or psychologist must be consulted with the affected child. This is especially true if accidents or falls occur during a seizure. If an affected child describes “fantastic images” and/or perceives certain body parts to be larger or smaller, the syndrome should be clarified immediately. In most cases, the Alice in Wonderland syndrome is based on a comparatively harmless underlying condition such as migraine, which can be treated without any problems. However, if the cause remains untreated, Alice in Wonderland syndrome can develop into severe psychological disorders. In addition, the seizures can lead to exclusion in everyday life. At the latest when parents notice changes in their child and symptoms mentioned, they should talk to an appropriate specialist.
Treatment and therapy
Since Alice in Wonderland syndrome represents a neurological symptom complex that is still largely unexplored and whose pathogenesis and etiology are not fully understood, it cannot be treated causally. Accordingly, the therapeutic measures for Alice in Wonderland syndrome usually start with the diagnosed underlying diseases. Thus, in addition to the recommendation for strict rest during attack phases, measures for the prophylaxis of migraine attacks are used. Antidepressants (amitriptyline), anticonvulsants, calcium antagonists or calcium channel blockers, analgesics and NSAID painkillers are used for this purpose. In the case of very severe seizures, sedatives (tranquilizers) can also be used for a short time to reduce the symptoms.In addition, a special migraine diet is recommended, in which chocolate, an excessively meat-heavy diet, refined sugar and the majority of denatured foods should be avoided. If the Alice in Wonderland syndrome is caused by epilepsy, this is usually treated with anticonvulsants or so-called “seizure blockers” (including carbamazepine, eslicarbazepine acetate, oxcarbazepine, valproic acid, benzodiazepines, zonisamide, phenobarbital). If the patient is resistant to drug therapy, surgical intervention (epilepsy surgery) may be considered, in which the area of the brain responsible for the seizures can be removed if necessary. In addition, dietary measures accompanying the therapy (ketogenic diet) are suggested. If the Alice in Wonderland syndrome can be traced back to alcohol abuse, alcohol abstinence is indicated. In addition, psychotherapeutic measures support those affected not only with regard to dealing with the underlying disease, but also with regard to Alice in Wonderland syndrome.
Outlook and prognosis
Due to Alice in Wonderland syndrome, in most cases, the patient’s perception is severely disturbed. In this case, various stimuli and information cannot be processed or assigned correctly, which can lead to significant limitations and problems in the patient’s daily life. Most patients suffer from dizziness or anxiety. There is also an increased sensitivity to light and not infrequently epileptic seizures. Migraine attacks also occur and may be accompanied by confusion. Furthermore, patients may suffer from hallucinations, which also reduces the quality of life. Sleep disturbances often occur as a result of the symptoms. Psychological upsets or depression can also complicate the patient’s life. Patients are often dependent on the help of other people in their lives. Treatment of Alice in Wonderland syndrome can take place with the help of therapies and medications. It is usually impossible to universally predict whether this will result in a positive course of the disease. The consumption of alcohol can also have a negative effect on the syndrome or even intensify it. Similarly, life expectancy may also be reduced.
Prevention
Because the exact pathogenesis and etiology of Alice in Wonderland syndrome have not yet been conclusively determined, it cannot be directly prevented. However, therapeutic measures for the specific underlying disorder should be consistently followed to prevent potential seizures and thus Alice in Wonderland syndrome.
Follow-up
Alice in Wonderland syndrome often requires extensive follow-up. The reason for this finding lies in its complex intermingling with other mental abnormalities. While Alice in Wonderland syndrome often resolves itself in children at puberty, this is usually not the case in adolescents and adults. Here, both physical and psychological disorders can occur in combination with Alice in Wonderland syndrome. These can include serious consequences such as epilepsy, brain lesions or severe viral infections. These require treatment. They also require long-term medical monitoring. Follow-up care for Alice in Wonderland syndrome must be based on the symptomatology and any sequelae that occur. Sufferers often experience severe perceptual disturbances such as panic attacks or hallucinations. The perception of space or time may also change. This greatly unsettles those affected. It is problematic that there are no effective therapeutic concepts for Alice in Wonderland syndrome. Consequently, aftercare also suffers from a conceptual lack of effective therapeutic principles. Therapy and aftercare measures initially address the underlying
diseases or the severe secondary diseases. Otherwise, aftercare can only be symptomatic. It is carried out with medication. Follow-up care for children is particularly difficult. It is little consolation that the affected child often experiences the spontaneous disappearance of the distressing disorders during puberty.
Here’s what you can do yourself
To date, the exact pathogenesis and etiology of Alice in Wonderland syndrome has not been clearly established.Therefore, physicians cannot give concrete advice on how patients can effectively prevent the syndrome. In a large number of cases, however, at least the responsible causes can be counteracted preventively. The focus is therefore on treating the underlying disease. In order to avoid potential seizures, the affected person should consistently pursue therapeutic measures for the individual underlying disease. In terms of prevention, excessive consumption of alcohol or the use of drugs should be avoided as a matter of principle. A change in diet is also considered immensely important. In order to prevent the syndrome from appearing, the prescribed medication should be taken in the prescribed cycle. If the symptoms are severe and acute, the affected person should go to a familiar and trusted environment and, if possible, be reassured by a trusted person. If there is no improvement or the symptoms even worsen, a physician may administer a sedative for a short period of time to alleviate or allow the seizure to subside.
