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When you don’t know what Alice in Wonderland syndrome (AIWS) is, it’s not shocking. This neurological dysfunction is so uncommon that some neurologists — even those that specialize within the ailments it sometimes accompanies, together with migraine and epilepsy — can see sufferers for many years and by no means encounter it.
Folks with Alice in Wonderland syndrome have episodes the place objects and even components of their very own our bodies can appear a lot smaller or a lot bigger than they really are. Alice in Wonderland syndrome was first described in 1952 and — based on one assessment — was given its title in 1955 by John Todd, an English psychiatrist.
The situation is generally present in kids, although which may be due, no less than partially, to an unwillingness in adults to explain the distortions they see, says Annette E. Grefe, MD, a pediatric neurologist at Wake Forest Baptist Health in Winston-Salem, North Carolina.
“That is conjecture, however some adults is perhaps afraid that individuals would assume they had been sort of loopy, as a result of what they expertise feels like a hallucination,” says Dr. Grefe.
As Alice herself famously mentioned within the e-book Alice’s Adventures in Wonderland, printed in 1865, “That is getting curiouser and curiouser!”
Right here’s what it’s prefer to have Alice in Wonderland syndrome, in addition to the way it’s identified and handled.
1. Issues Seem A lot Greater or A lot Smaller Than They Actually Are
Folks with AWIS report perceiving adjustments of their environment, based on Anjan Okay. Chatterjee, MD, a neurologist at Penn Medication in Philadelphia. “Often, a bout consists of both micropsia, the place objects seem small, or macropsia, the place issues look greater than they really are,” says Dr. Chatterjee.
In some instances, it’s not simply an exterior object that appears to vary dimension; individuals experiencing Alice in Wonderland syndrome might understand their very own physique components in a distorted manner, both a lot greater or a lot smaller, he says.
“These episodes can final for minutes and typically longer — it’s not fast — or it’s a two-second factor the place you rub your eyes and every part is healthier,” says Chatterjee.
Understandably, individuals can have some anxiousness and worry about what’s inflicting these perceptions, particularly after they expertise AIWS for the primary time.
For individuals who proceed to have episodes, it could finally be extra mystifying than horrifying, however it depends upon the character of the person, Chatterjee says.
2. Lewis Carroll Himself Could Have Had AIWS
Lewis Carroll (the pen title of Charles Lutwidge Dodgson) was the creator of Alice’s Adventures in Wonderland, and it’s doable he was influenced by his personal expertise of migraine in writing the e-book.
Within the e-book, Alice finds a bottle labeled “Drink me,” and when she does, she shrinks to lower than a foot tall. Nearly instantly afterward, she consumes a cake that causes her to develop very tall, till her head hits the ceiling.
“It truly seems that the creator Lewis Carroll most likely had a migraine, primarily based on a few of his diary entries,” says Chatterjee. It’s been speculated that he might have skilled Alice in Wonderland syndrome himself, and that will have been a part of the origin of a few of these uncommon components in these tales, he says.
3. Consultants Aren’t Certain What Causes Alice in Wonderland Syndrome
We don’t know precisely what’s going on to trigger individuals to see objects as bigger or smaller than they are surely, says Grefe. “There are some theories that make sense from an anatomical foundation,” she says.
When Alice in Wonderland syndrome accompanies migraine, it could originate from the parieto-occipital a part of the mind, based on Grefe. “The parietal space has to do with notion of the physique and notion of house, and the occipital space has to do with imaginative and prescient,” says Grefe.
When AIWS is said to epilepsy, it appears to originate within the frontal lobe, however there’s nonetheless so much to be discovered about that, she provides.
4. AIWS Is Uncommon however Could Be Underdiagnosed
Alice in Wonderland syndrome is so uncommon that many specialists might by no means encounter it of their profession, says Chatterjee.
However though specialists agree that it’s uncommon, the general prevalence isn’t recognized. To this point, no epidemiological research have been performed that may present how frequent AIWS is within the inhabitants.
And no universally accepted method to diagnose the syndrome exists both, based on one assessment. Two individuals might current with the identical signs, and one would possibly get a prognosis of AIWS and one won’t.
The dearth of prognosis can also be as a result of some individuals don’t like to speak about their signs; they might worry that individuals will assume they’re hallucinating or have a psychological sickness. This case was described in a first-person account printed in The New York Occasions.
5. Alice in Wonderland Syndrome Could Be A part of the Aura in a Migraine Assault
Though AIWS could be very uncommon, when it’s reported, it’s typically related to migraine.
“I feel most sometimes it happens as a part of the aura” — the part of a migraine earlier than the headache begins — “however it could occur in the course of the headache as effectively,” says Chatterjee.
And like different experiences of migraine aura, the notion adjustments caused by Alice in Wonderland syndrome might happen with none headache in any respect, he says.
When an individual has a migraine episode with out head ache, it’s referred to as “typical aura with out headache” or typically referred to as a “silent” migraine, based on the American Migraine Basis.
6. AIWS Can Additionally Be Associated Epilepsy, Infections, and Different Mind Issues
There are different circumstances in addition to migraine related to Alice in Wonderland syndrome, says Grefe.
“This would come with temporal epilepsy, in addition to sure sorts of infections — viral infections, comparable to mono or the flu,” she says.
Mono, or infectious mononucleosis, is most frequently brought on by the Epstein-Barr virus (EBV), a sort of herpesvirus and probably the most frequent human viruses, based on the Facilities for Illness Management and Prevention (CDC). Most individuals get it sooner or later of their lives. In uncommon instances, EBV can result in issues comparable to encephalitis (swelling of the mind), which is usually the reason for AIWS in kids.
Not often, Alice in Wonderland syndrome is an indication of a stroke or mind tumor, says Chatterjee. “That’s very uncommon, and often you’ll have many different signs along with the visible signs of Alice in Wonderland syndrome,” he says.
AIWS can also be brought on by sure medicine, comparable to LSD or different hallucinogens. And “there are undoubtedly psychiatric problems the place these sorts of misperceptions are a part of the signs,” says Chatterjee.
7. Remedy Entails Treating the Underlying Situation
Though no standardized tips on diagnosing AIWS have been issued by a medical group, it’s strongly really helpful that when an individual has signs of the dysfunction, the assorted potential underlying causes be investigated with blood exams, EEG (electroencephalogram), and mind MRI.
An EEG detects adjustments in mind exercise and can be utilized to diagnose epilepsy and different seizure problems. MRIs may help diagnose circumstances comparable to tumor, an infection, swelling, or harm brought on by an harm or stroke.
To diagnose for migraine, a bodily examination and the individual’s signs and medical historical past are examined.
There’s no particular remedy for Alice in Wonderland syndrome, says Chatterjee. “The remedy depends upon what’s inflicting the visible disturbance — if it’s migraine, we’d use migraine remedy. That will imply preventive remedy if in case you have migraine regularly, and as-needed acute migraine remedy for the assault,” he says.
If the Alice in Wonderland syndrome is said to seizure, then seizure remedy could be acceptable, provides Chatterjee.
“There’s one thing taking place within the physiology of migraine or one other underlying situation that’s kicking off these perceptual phenomena,” says Chatterjee. For that cause, you wouldn’t give remedy particularly for the AIWS visible disturbance, he says.
“That’s one factor that makes this completely different from hallucinations or delusions, the place you would possibly need to give individuals drugs to attempt to suppress no matter is producing these visible photos from the inside of our brains,” he says.
Since Alice in Wonderland syndrome shouldn’t be like that, you’ll deal with individuals for his or her migraine or epilepsy or some other underlying trigger, thereby treating the dysfunction itself, not the expression of the dysfunction, says Chatterjee.
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