Wonderland Syndrome Research Articles

Atypical Symptoms in Migraine-Related Alice in Wonderland Syndrome: Expansion of the Phenotype and Reflection on the Pathomechanism

We report an 8-year-old girl who experienced daily episodes of visual and somesthetic distortion and was diagnosed with Alice in wonderland syndrome (AIWS). Ophthalmologic assessment revealed best-corrected visual acuity of 0.2 in both eyes, and bilateral constricted tubular or spiral visual fields. Augmented amplitude of visually evoked potentials was revealed, and treatment with lomerizine and valproate showed favorable effect on the visual/somesthetic distortion as well as the visual field and acuity. Psychogenic visual problems can co-exist with the typical sensory distortion in AIWS, similarly to the case of psychogenic pseudo-seizures in subjects with epilepsy. Otherwise, an ambiguous borderline between psychological and physical pathomechanisms in migraine may also be characteristic of the migraine-related AIWS.

Salvia divinorum induces body awareness changes comparable to metamorphic symptoms in the Alice in Wonderland syndrome

Salvia divinorum induces body awareness changes comparable to metamorphic symptoms in the Alice in Wonderland syndrome

How do the body schema and the body image interact?

Despite their differences, body schema and the body image representations are not only consistent in everyday life, but also sometimes consistent in pathological disorders, such as in Alice in Wonderland syndrome and anorexia nervosa. The challenge is to understand how they achieve such consistency. Recently, we suggested that these two representations were co-constructed (Pitron & Vignemont, 2017). In his reply, Gadsby (2018) invited us to clarify how this co-construction works and to what extent the body schema and the body image can reshape each other. Here we motivate conceptual grounds for a model on which these two forms of representation modify one another and explore theoretical options for the way(s) in which they might do so. In particular, we highlight the virtues of a serial model in which the body schema has some primacy over the body image, while also acknowledging the special role played by the body image.

Clinical characteristics of Alice in Wonderland syndrome in a cohort with vestibular migraine.

Alice in Wonderland syndrome (AIWS) is a rare sensory perception disorder, most often caused by migraine in adults. We aimed to characterize the clinical characteristics of AIWS in a cohort of vestibular migraine (VM) patients. Retrospective chart review of patients diagnosed with VM seen between August 2014 and January 2018. Seventeen patients were identified (10 women) with a median age at onset of 45 years (range 15-61 years), and median age at presentation of 49 years (range 17-63 years). Eighty-two percent reported 1 AIWS symptom, 12% reported 3 symptoms, and 6% described 2 symptoms. The most common symptom was visual distortions (47%), followed by extrapersonal misperceptions (41%) and somesthetic distortions (29%). Most AIWS occurred during VM episodes (77%). Eleven patients were seen in follow-up; 10 described complete or partial resolution of both AIWS and VM with migraine preventive therapy, while 1 experienced complete resolution of VM but continued to have AIWS. Neuro-otologic abnormalities improved in 2 patients. This study characterizes the clinical features of AIWS in patients with VM. We observed several rare and highly unusual AIWS misperceptions (frosted-glass vision, underwater vision, dolly zoom effect, sensation of the brain coming out of the head, closed-eye visual hallucinations, and headlight glare-induced marco/microsomatognosia), and resolution or improvement in AIWS and VM with migraine preventive treatment.

Alice in Wonderland syndrome: a novel neurological presentation of Zika virus infection.

Zika virus (ZIKV) is a flavivirus endemic in Africa and Southern Asian countries, which has recently emerged in unprecedented epidemic proportions around the world. Although ZIKV infection is often asymptomatic or distinguished by non-specific influenza-like symptoms, an increase in its pathogenicity and biological behavior has been the hallmark of the current pandemic. Increasing evidence suggests that neurotropic strains of ZIKV have evolved from less pathogenic strains of the virus. Neurological manifestations of ZIKV infection include a spectrum of congenital and non-congenital clinical entities, however visual somatosensory perceptual disorders have not been recorded to date. Herein, we report a case of a 15-year-old female who presented with a constellation of perceptual symptoms (metamorphopsia, telopsia, and pelopsia) following acute ZIKV infection. Although such symptoms may have originated from direct viral injury, a post-ZIKV autoimmune reaction to previously unexposed neuronal surface antigens or through molecular mimicry cannot be excluded. The development of Alice in Wonderland syndrome in our patient highlights the ever-increasing expanding spectrum of neurological symptoms associated to ZIKV infection.

Alice in Wonderland Syndrome (AIWS). A reflection

The Alice in Wonderland syndrome is a rare clinical neurological condition, defined by the presence of perception disorders usually interpreted by the affected patient as rare metamorphosing and depersonalization phenomena. Due to its extremely rare occurrence and its surreal and sometimes psychedelic character, the syndrome has been associated with the phenomena experienced by Alice, the character in the classic and world-famous story by Lewis Carroll.

Alice in Wonderland Syndrome in a Child with an Electroencephalographic Abnormality: A Case Report

AWS은 갑작스러운 자신의 신체 크기 혹은 모양이 다르게 보이는 증상을 특징으로 하는 증후군이지만, 어린 아이나 15세 이하의 청소년에서는 사물이 작게 보이거나 멀리 보이는 것과 같은 시각적 증상이 흔하게 관찰된다. AWS를 설명하기 위해 여러 가지 이론이 존재하며, 그 중 흔히 받아 들이는 것은 편두통과 연관성을 갖는 것이다. 하지만 문헌상으로 단순...

“The origin of Alice in Wonderland Syndrome: Charles Dodgson and his attraction to small children”

1864, Lewis Carroll wrote the novel of Alice in Wonderland “Alice`s Adventures under Ground”. Lewis Carroll was the pseudonym of the researcher Charles Lutwidge Dodgson. His fondness for small children led to the writing of “Alice`s Adventures in Wonderland”, which was published in 1865, a story beginning with rowing Lorina, Alice and Edith, the three small daughters of the College Dean H.G. Liddell, through the Thames for a picnic near the city of Binsey. Charles Dodgson had a fable for small children and painted them nakely. Dodgson spent special attention to small children with paintings and photographs. Charles Dodgson wrote diary about the experience with the three daughters, especially Alice, unfortunately diaries between 18.4.1858 till 8.5.1862 were missing. These parts of the diary were never found.

Location of activation on ankle SPECT CT scan predicts pre- and post-operative functional and pain

Migraines are a common paroxysmal disorder that may present with a multitude of neurologic symptoms. Migraines have been re-categorized in the most recent edition of the International Classification of Headache Disorders. In this article, we review the literature on hemiplegic migraines, alternating hemiplegia of childhood, migraine with brainstem aura, retinal migraine, ophthalmoplegic migraine, Alice in Wonderland syndrome, and acute confusional migraine. We also discuss the principal clinical features, diagnostic criteria, and treatment options for these disorders.

A case of recurrent depressive disorder presenting with Alice in Wonderland syndrome: psychopathology and pre- and post-treatment FDG-PET findings

BackgroundAlice in Wonderland syndrome (AIWS) is a rare neuropsychiatric syndrome that typically manifests in distortion of extrapersonal visual image, altered perception of one’s body image, and a disturbed sense of the passage of distance and time. Several conditions have been reported to contribute to AIWS, although its biological basis is still unknown. Here, we present the first case demonstrating a clear concurrence of recurrent depressive disorder and AIWS. The clinical manifestations and pre- and post-treatment fluorodeoxyglucose positron-emission tomographic (FDG-PET) images provide insights into the psychopathological and biological basis of AIWS.Case presentationWe describe a 63-year-old Japanese male who developed two distinct episodes of major depression concurrent with AIWS. In addition to typical AIWS perceptual symptoms, he complained of losing the ability to intuitively grasp the seriousness of news and the value of money, which implies disturbance of high-order cognition related to estimating magnitude and worth. Both depression and AIWS remitted after treatment in each episode. Pre-treatment FDG-PET images showed significant hypometabolism in the frontal cortex and hypermetabolism in the occipital and parietal cortex. Post-treatment images showed improvement of these abnormalities.ConclusionsThe clinical co-occurrence of depressive episodes and presentation of AIWS can be interpreted to mean that they have certain functional disturbances in common. In view of incapacity, indifference, devitalization, altered perception of one’s body image, and disturbed sense of time and space, the features of AIWS analogous to those of psychotic depression imply a common psychopathological basis. These high-order brain dysfunctions are possibly associated with the metabolic abnormalities in visual and parietotemporal association cortices that we observed on the pre- and post-treatment FDG-PET images in this case, while the hypometabolism in the frontal cortex is probably associated with depressive symptoms.

The Alice in Worderland Syndrome

ABSTRACTThe Alice in Wonderland Syndrome (AWS) was first described more than 60 years ago by Lippman. It refers to episodes during which an individual may variously experience (as did Alice during her time in Wonderland) somatic, visuo-perceptual and/or visuo-spatial hallucinations, as well as feelings of depersonalisation, derealisation and distorted sense of time. Although the prevalence of AWS is unknown, indirect evidence from both retrospective and prospective studies suggests that it is a rare disorder. This paper describes the case of Zoe, a right-handed, native English speaker who was age 45 years when she experienced an episode of AWS. On neuropsychological assessment, Zoe demonstrated notable impairment of attention, learning and recall (particularly for visuo-spatial information) as well as executive dysfunction (viz., impairment of planning, cognitive flexibility and abstraction), consistent with fronto-temporal dysfunction. Detailed profiles of neuropsychological impairment in the context of AWS have not previously been reported, and it is unclear if such impairment is, indeed, a central and characteristic feature of AWS.

Tart Cherry Juice Consumption as a Potential Treatment for Migraine Headaches

PURPOSE: Anti-inflammatory and antioxidant effects of tart cherry juice accelerate exercise recovery (Bell 2013). These effects likely yield additional health benefits. The purpose of this study was to examine the effect of regular consumption of tart cherry juice on frequency, intensity and duration of migraine headaches in a single patient with a 4-year history of migraines. The study rationale was threefold: (1) migraineurs have elevated c-reactive protein (CRP) and nitric oxide (NO) (Lippi 2014; van der Kuy & Lohman 2003); (2) cherries can reduce CRP and NO (Kelley 2006); (3) tart cherry anthocyanin bioavailability is high in brain tissue (Kirakosyan 2015). METHODS: The 24 yo female patient had a 4-year history of migraine headache with aura, sensory (pins-and-needles) and visual disturbance (Alice in Wonderland syndrome); and was taking Zolmitriptan (2.5 mg) to treat migraine occurrences. A 3-phase study was completed: Phase 1 - 50 days without cherry juice; Phase 2 - 50 days drinking 8 fl oz tart cherry juice daily (Cheribundi, Geneva NY); Phase 3 - 50 days without cherry juice. Migraine frequency (migraines/week), duration (hours/migraine), intensity (VAS pain 0-10 scale) and medication use (pills/week) were documented. RESULTS: When taking tart cherry juice migraine frequency and duration were reduced by 65% and 78%, respectively. Medication use was reduced by 91%. Migraines occurred during 3 of 4 menstrual cycles when the patient was not taking cherry juice, but during neither menstrual cycle when the patient was taking cherry juice.Table: No title available.CONCLUSIONS: Given the scientific rationale for the potential benefits of cherry juice in preventing migraine headaches, and the positive results of this pilot study, a clinical trial is warranted.

Migrainous Aura, Visual Snow, and “Alice in Wonderland” Syndrome in Childhood

Migraine is a condition that is common in the pediatric and adolescent population. Among children with migraine, visual aura can consist of either negative or positive features or both. Reports of sensory auras can also be elicited with a careful history. The understanding of the types of aura, as well as their relation to the more typical features of migraine, are discussed. The similar phenomena of visual snow and Alice in Wonderland syndrome in children are also described in detail.

Complicated Migraines

Migraines are a common paroxysmal disorder that may present with a multitude of neurologic symptoms. Migraines have been re-categorized in the most recent edition of the International Classification of Headache Disorders. In this article, we review the literature on hemiplegic migraines, alternating hemiplegia of childhood, migraine with brainstem aura, retinal migraine, ophthalmoplegic migraine, Alice in Wonderland syndrome, and acute confusional migraine. We also discuss the principal clinical features, diagnostic criteria, and treatment options for these disorders.

Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review.

Alice in Wonderland Syndrome (AIWS) is a perceptual disorder, principally involving visual and somesthetic integration, firstly reported by Todd, on the literary suggestion of the strange experiences described by Lewis Carroll in Alice in Wonderland books. Symptoms may comprise among others aschematia and dysmetropsia. This syndrome has many different etiologies; however EBV infection is the most common cause in children, while migraine affects more commonly adults. Many data support a strict relationship between migraine and AIWS, which could be considered in many patients as an aura or a migraine equivalent, particularly in children. Nevertheless, AIWS seems to have anatomical correlates. According to neuroimaging, temporoparietal-occipital carrefour (TPO-C) is a key region for developing many of AIWS symptoms. The final part of this review aims to find the relationship between AIWS symptoms, presenting a pathophysiological model. In brief, AIWS symptoms depend on an alteration of TPO-C where visual-spatial and somatosensory information are integrated. Alterations in these brain regions may cause the cooccurrence of dysmetropsia and disorders of body schema. In our opinion, the association of other symptoms reported in literature could vary depending on different etiologies and the lack of clear diagnostic criteria.

Alice in Wonderland Syndrome, Burning Mouth Syndrome, Cold Stimulus Headache, and HaNDL: Narrative Review.

Unusual headache syndromes are not as infrequent in clinical practice as was generally believed. About three fourths of the classified headache disorders found in the ICHD-II can be considered rare. The aim of this narrative review was to perform a literature review of the pathophysiology, clinical presentation, diagnostic criteria, and treatment of the following unusual headache disorders: Alice in Wonderland syndrome, burning mouth syndrome, cold stimulus headache, and the syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis. A literature review was performed using PubMed for each of the abovementioned headache disorders. The unusual headache syndromes as a distinct group of disorders are not as infrequent in clinical practice as was generally believed. Some of them, albeit considered as unusual, may occur with relative frequency, such as cold stimulus headache and burning mouth syndrome.

The Alice in Wonderland Syndrome: A Case of Aura Accompanying Cluster Headache.

Cluster headache (CH) is a primary headache which has highly specific and sensitive criteria, and notpresence of an aura. It has been recently reported that CH may not presence with aura more than ever and this condition will be identified by headache specialists as a new form of CH. As there is no report to our knowledge on Alice in Wonderland syndrome (AIWS) manifested as CH aura in the literature, we present a case of a 35-year-old man having AIWS as CH aura. Clinically, AIWS is not uncommon and is likely to be underestimated as a diagnostic entity. Valproate may be preferred for treatment in CH patients with AIWS aura.

Alice in Wonderland syndrome and hypermobility of the temporomandibular joint: association or coincidence?

Alice in Wonderland syndrome and hypermobility of the temporomandibular joint: association or coincidence?

Zespół Alicji w Krainie Czarów – czy tylko aura migrenowa u dzieci?

Zespół Alicji w Krainie Czarów – czy tylko aura migrenowa u dzieci?

Alice in Wonderland and Other Migraine Associated Phenomena—Evolution Over 30 Years After Headache Diagnosis

BackgroundThe International Classification of Headache Disorders-III beta includes a number of episodic syndromes associated with migraine. Those who treat pediatric headaches are aware of a number of other phenomena (such as the Alice in Wonderland syndrome) which are thought to occur as precursors of migraine. There is no available data on the course of these phenomena over the decades following childhood headache diagnosis. MethodsPatients who were observed by one of the authors in 1983 were contacted by telephone in 1993, 2003, and 2013. Details were gathered regarding the presence and characteristics of ongoing headaches and about the presence of sleepwalking, motion sickness, and distortions of either time or space perceptions. ResultsTwenty-eight patients were monitored in 1993, 2003, and 2013. Ongoing headaches were reported by 71%. Sleepwalking was only present in one patient in 2013. More than a third still complained of motion sickness, and more than one quarter still experienced distortions of time. Distortions of space were still reported by nearly 20%. Reporting any of these phenomena was not consistent over time, with some patients reporting distortions for the first time in adulthood. There was no clear correlation with migraine, and patients with tension-type headaches also reported the phenomena. ConclusionsMotion sickness and distortions of both space and time persist into the fifth decade for many patients initially observed with headaches in childhood. The correlation with migraine is less clear than previously thought.