Alice in Wonderland syndrome: Difference between revisions

Alice in Wonderland syndrome
Alice in Wonderland syndrome
Other names	Todd's syndrome, Lilliputian hallucinations, dysmetropsia
	The perception a person can have due to micropsia, a potential symptom of dysmetropsia. From Lewis Carroll's 1865 novel Alice's Adventures in Wonderland
Specialty	Psychiatry, neurology
Symptoms	Micropsia (disoriented perception on objects)
Complications	Impaired vision
Usual onset	Before, during, or after a migraine
Duration	Each symptom is separate and will only occur for a 20-to-50-minute period of time.

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Alice in Wonderland syndrome (AIWS), also known as Todd's syndrome or dysmetropsia, is a neuropsychological condition that causes a distortion of perception. People may experience distortions in visual perception of objects such as appearing smaller (micropsia) or larger (macropsia), or appearing to be closer (pelopsia) or farther (teleopsia) away than they actually are. Distortion may occur for other senses besides vision as well.

The cause of Alice in Wonderland syndrome is currently unknown, but has often been associated with migraines, head trauma, or viral enecephalitis caused by Epstein–Barr virus infection.^[4] Alice in Wonderland syndrome can be caused by abnormal amounts of electrical activity resulting in abnormal blood flow in the parts of the brain that process visual perception and texture.^[5]

Although there have been cases of Alice in Wonderland syndrome in adolescents and adults, it is most commonly seen in children. ^[6]

Signs and symptoms

Alice in Wonderland syndrome affects the sense of vision, sensation, touch, and hearing, as well as the perception of one's own body image.^[7] Migraines, nausea, dizziness, and agitation are also commonly associated symptoms with Alice in Wonderland syndrome.^[8] Less frequent symptoms also include loss of limb control and coordination, memory loss, lingering touch and sound sensations, and emotional instability.^[9] Alice in Wonderland syndrome is characterized by the individual being able to recognize the distortion in the perception of their own body^[10] and is episodic in nature.

Visual distortions

Individuals with Alice in Wonderland syndrome can experience illusions of expansion, reduction or distortion of their own body image, such as microsomatognosia (feeling that their own body or body parts are shrinking), or macrosomatognosia (feeling that their body or body parts are growing taller or larger). These changes in perception are collectively known as metamorphosias, or Lilliputian hallucinations,^[9] which refers to objects appearing either smaller or larger than reality.^[11] People with certain neurological diseases have also experienced similar visual hallucinations.^[12]

Within the category of Lilliputian hallucinations, people may experience either micropsia or macropsia. Micropsia is an abnormal visual condition, usually occurring in the context of visual hallucination, in which the affected person sees objects as being smaller than they are in reality.^[13] Macropsia is a condition where the individual sees everything larger than it actually is.^[14]

Alice in Wonderland syndrome episodes vary in length from person to person. Episodes typically last from a few minutes to an hour, and each episode may vary in experience^[15].

Hallucinations

Zoopsia is an additional hallucination that is sometimes associated with Alice in Wonderland syndrome. Zoopsias involve hallucinations of either swarms of small animals (e.g. ants and mice etc.), or isolated groups of larger animals (e.g. dogs and elephants etc.).^[16] This experience of zoopsias is shared symptom of a variety of conditions, such as delirium tremens.^[17]

In addition, some people may, in conjunction with a high fever, experience more intense and overt hallucinations, seeing things that are not there and misinterpreting events and situations.^[18]

Depersonalization/Derealization

Along with these size, mass, and shape distortions of the body, those with Alice in Wonderland syndrome often experience a feeling of disconnection from one's own body, feeling, thoughts, and environment. ^[6]

Hearing and time distortions

Sufferers of Alice in Wonderland syndrome can also often experience paranoia as a result of disturbances in sound perception. These disturbances can include amplification of soft sounds or misinterpretation of common sounds.^[19]^[20]

A person affected by Alice in Wonderland syndrome may also lose a sense of time, a problem similar to the lack of spatial perspective brought on by visual distortion. Time may seem to pass very slowly, akin to an LSD experience, and the lack of time and space perspective can also lead to a distorted sense of velocity. For example, one could be inching along ever so slowly in reality, yet to an affected person, it would seem as if one were sprinting uncontrollably along a moving walkway, leading to severe, overwhelming disorientation.^{[citation needed]}

Causes

Because Alice in Wonderland syndrome is not commonly diagnosed and documented, it is difficult to estimate what the main causes, if any are. The cause of over half cases is unknown.^[21] Complete and partial forms of the Alice in Wonderland syndrome exist in a range of other disorders, including epilepsy, intoxicants, infectious states, fevers, and brain lesions.^[9] Furthermore, the syndrome is commonly associated with migraines, as well as the use of psychoactive drugs. It can also be the initial symptom of the Epstein–Barr virus (see mononucleosis), and a relationship between the syndrome and mononucleosis has been suggested.^[22]^[23]^[24]^[8] Within this suggested relationship, Epstein–Barr virus appears to be the most common cause in children, while for adults it is more commonly associated with migraines.^[25]

Infectious Diseases

A 2021 review found that infectious diseases are the most common cause of Alice in Wonderland syndrome, especially in pediatrics. Some of these infectious agents included Epstein–Barr virus, Varicella Zoster virus, Influenza, Zika, Coxsackievirus, Plasmodium falciparum protozoa, and Mycoplasma pneumoniae/Streptococcus pyogenes bacteria.^[26] Association of Alice in Wonderland syndrome is most commonly seen with Epstein-Barr virus. However, pathogenesis is not well understood beyond these reviews. In one instance, Alice in Wonderland syndrome was reported to be associated with an Influenza A infection^[27] and it is possible that there may be other unreviewed causes as well.

Cerebral hypotheses

AiWS can be caused by abnormal amounts of electrical activity resulting in abnormal blood flow in the parts of the brain that process visual perception and texture.^[5] Nuclear medical techniques using technetium, performed on patients during episodes of Alice in Wonderland syndrome, have demonstrated that AiWS is associated with reduced cerebral perfusion in various cortical regions (frontal, parietal, temporal and occipital), both in combination and in isolation. One hypothesis is that any condition resulting in a decrease in perfusion of the visual pathways or visual control centers of the brain may be responsible for the syndrome. For example, one study used single photon emission computed tomography to demonstrate reduced cerebral perfusion in the temporal lobe in patients with AiWS.^[28]

Other theories suggest the syndrome is a result of unspecific cortical dysfunction (e.g. from encephalitis, epilepsy, decreased cerebral perfusion), or reduced blood flow to other areas of the brain.^[9]^[8] Other theories suggest that distorted body image perceptions stem from within the parietal lobe. This has been demonstrated by the production of body image disturbances through electrical stimulation of the posterior parietal cortex. Other researchers suggest that metamorphopsias, or visual distortions, may be a result of reduced perfusion of the non-dominant posterior parietal lobe during migraine episodes.^[9]

Throughout all the neuroimaging studies, several cortical regions (including the temporoparietal junction within the parietal lobe, and the visual pathway, specifically the occipital lobe) are associated with the development of Alice in Wonderland syndrome symptoms.^[1]

Migraines

The role of migraines in Alice in Wonderland syndrome is still not understood, but both vascular and electrical theories have been suggested. For example, visual distortions may be a result of transient, localized ischaemia in areas of the visual pathway during migraine attacks. In addition, a spreading wave of depolarization of cells (particularly glial cells) in the cerebral cortex during migraine attacks can eventually activate the trigeminal nerve's regulation of the vascular system. The intense cranial pain during migraines is due to the connection of the trigeminal nerve with the thalamus and thalamic projections onto the sensory cortex. Alice in Wonderland syndrome symptoms can precede, accompany, or replace the typical migraine symptoms.^[9] Typical migraines (aura, visual derangements, hemi-cranial headache, nausea and vomiting) are both a cause and an associated symptom of AIWS.^[29]

Genetic and environmental influence

While there currently is no identified genetic locus/loci associated with Alice in Wonderland syndrome, observations suggest that a genetic component may exist but the evidence so far is inconclusive. There is also an established genetic component for migraines which may be considered to be a possible cause and influence for hereditary Alice in Wonderland syndrome.

One example of environmental influences on the incidence of Alice in Wonderland syndrome includes the drug use and toxicity of topiramate^[30]. Other reports of tyramine usage and the association with Alice in Wonderland syndrome has been reported but current evidence is inconclusive. Further research is required to establish the genetic and environmental influences on Alice in Wonderland syndrome.^[31]

Diagnosis

Alice in Wonderland syndrome is a disturbance of perception rather than a specific physiological condition. The diagnosis can be presumed when other causes have been ruled out. Additionally, AIWS can be presumed if the patient presents symptoms along with migraines and complains of onset during the day (although it can also occur at night). However, as there are no established diagnostic criteria for Alice in Wonderland syndrome, there is likely to be a large degree of variability in the diagnostic process and thus it can be poorly diagnosed.^[25]

Often, difficulty lies within the patient's reluctance to describe their symptoms out of fear of being labeled with a psychiatric disorder. Nonetheless, it is usually easy to rule out psychosis as those with Alice in Wonderland syndrome are typically aware that their hallucinations and distorted perceptions are not 'real'.^[31] Younger patients may struggle to describe their unusual symptoms, and thus, one recommended approach is to encourage children to draw their visual illusions during episodes.^[20]

Prognosis

The symptoms of Alice in Wonderland syndrome themselves are not inherently harmful, and are often not frightening to the person experiencing them. Since there is no established treatment for Alice in Wonderland syndrome, prognosis varies from patient to patient and based on if an underlying cause has been identified.^[32]

In cases of Alice in Wonderland Syndrome caused by underlying conditions, symptoms typically occur during the course of the underlying disease and last anywhere from a few days to months.^[31] In most cases, symptoms of Alice in Wonderland Syndrome disappear either spontaneously, with treatment of underlying causes, or after reassurances that syptoms are momentary and harmless.^[33] Some people do not experience any more episodes of symptoms after their first experience, while others have repeat episodes before symptoms resolve. Other patients continued to experience episodes years after the initial experience, sometimes with the development of new visual disorders or migraines.^[34]

Treatment

Because symptoms of Alice in Wonderland syndrome can often be fully cleared (spontaneously or with proper treatment), it is thought that most clinical and non-clinical AIWS cases are benign. However, symptoms tend to reappear during an active phase of an underlying chronic disease (e.g., migraine, epilepsy).^[35] At present, Alice in Wonderland syndrome has no standardized treatment plan. Rather, treatment methods revolve around migraine prophylaxis, as well as the promotion of a low tyramine diet. Drugs that may be used to prevent migraines include anticonvulsants, antidepressants, calcium channel blockers, and beta blockers. Other treatments that have been explored include repetitive transcranial magnetic stimulation (rTMS). Further research is required to establish an effective treatment regime.^[8] Visual distortion symptoms can also be relieved by getting close to and looking at the objects in question, and by slowly proceeding to look at things further away.^{[citation needed]}

Epidemiology

The lack of established diagnostic criteria or large-scale epidemiological studies on Alice in Wonderland syndrome means that the exact prevalence of the syndrome is currently unknown. One study on 3,224 adolescents in Japan demonstrated the occurrence of macropsia and micropsia to be 6.5% in boys and 7.3% in girls, suggesting that the symptoms of Alice in Wonderland syndrome may not be particularly rare.^[36] This also seems to suggest a difference in the male/female ratio of Alice in Wonderland syndrome patients. However, according to other studies, it appears that the male/female ratio is dependent on the age range being observed. Studies showed that younger males (age range of 5 to 14 years) were 2.69 times more likely to experience Alice in Wonderland syndrome than girls of the same age, while there were no significant differences between students of 13 to 15 years of age. Conversely, female students (16- to 18-year-olds) showed a significantly greater prevalence.^[25]

The average age of the start of Alice in Wonderland syndrome is six years old, but it is very normal for some patients to experience the syndrome from childhood up to their late 20s.^[8] Because many parents who have Alice in Wonderland syndrome report their children having it as well, the condition is thought possibly to be hereditary.^[37]

History

The syndrome is sometimes called Todd's syndrome, in reference to an influential description of the condition in 1955 by Dr. John Todd (1914–1987), a British consultant psychiatrist at High Royds Hospital at Menston in West Yorkshire.^[38]^[39]^[40] Dr. Todd discovered that several of his patients experienced severe headaches causing them to see and perceive objects as greatly out of proportion. In addition, they had altered sense of time and touch, as well as distorted perceptions of their own body. Despite having migraine headaches, none of these patients had brain tumors, damaged eyesight, or mental illness that could have accounted for these and similar symptoms. They were also all able to think lucidly and could distinguish hallucinations from reality, however, their perceptions were distorted.^[41]

Since Lewis Carroll had been a well-known migraine sufferer with similar symptoms, Dr. Todd speculated that Carroll had used his own migraine experiences as a source of inspiration for his famous 1865 novel Alice's Adventures in Wonderland. Carroll's diary reveals that in 1856 he consulted William Bowman, an eminent ophthalmologist, about the visual manifestations of the migraines he regularly experienced.^[42]

Society and culture

Gulliver's Travels

Alice in Wonderland syndrome's symptom of micropsia has also been related to Jonathan Swift's novel Gulliver's Travels. It has been referred to as "Lilliput sight" and "Lilliputian hallucination", a term coined by British physician Raoul Leroy in 1909,^[43] based on the small people that inhabited the island of Lilliput in the novel.^[44]

Alice in Wonderland

Alice in Wonderland syndrome was named after Lewis Carroll's famous 19th-century novel Alice's Adventures in Wonderland. In the story, Alice, the titular character, experiences numerous situations similar to those of micropsia and macropsia. The thorough descriptions of metamorphosis clearly described in the novel were the first of their kind to depict the bodily distortions associated with the condition. There is some speculation that Carroll may have written the story using his own direct experience with episodes of micropsia resulting from the numerous migraines he was known to suffer from.^[45] It has also been suggested that Carroll may have suffered from temporal lobe epilepsy.^[46]

House

The condition is diagnosed in the season 8 episode Risky Business.

Doctors

In April 2020, a case of Alice in Wonderland syndrome was covered in an episode of the BBC daytime soap opera Doctors, when patient Hazel Gilmore (Alex Jarrett) experienced it.^[47]

References

^ Longmore M, Wilkinson I, Turmezei T, Cheung CK (2007). Oxford Handbook of Clinical Medicine. Oxford. p. 686. ISBN 978-0-19-856837-7.
^ "Alice and Wonderland Syndrome and Visual Migraines".
^ "Alice in Wonderland Syndrome | Symptoms & Treatment". Share.upmc.com. 2016-10-25. Retrieved 2019-08-30.
^ Cinbis M, Aysun S (May 1992). "Alice in Wonderland syndrome as an initial manifestation of Epstein-Barr virus infection". Br J Ophthalmol. 76 (5): 314. doi:10.1136/bjo.76.5.316. PMC 504267. PMID 1390519.
^ ^a ^b Feldman, Caroline (April 7, 2008). "A Not So Pleasant Fairy Tale: Investigating Alice in Wonderland Syndrome". Serendip. Serendip Studio, Bryn Mawr College. Archived from the original on November 9, 2008. Retrieved 25 November 2011.
^ ^a ^b Lanska, Douglas J.; Lanska, John R. (2018), Bogousslavsky, J. (ed.), "The Alice-in-Wonderland Syndrome", Frontiers of Neurology and Neuroscience, vol. 42, S. Karger AG, pp. 142–150, doi:10.1159/000475722, ISBN 978-3-318-06088-1, retrieved 2021-07-27
^ Stapinski H (23 June 2014). "I Had Alice in Wonderland Syndrome". The New York Times. Archived from the original on 6 September 2015.
^ ^a ^b ^c ^d ^e O'Toole P, Modestino EJ (June 2017). "Alice in Wonderland Syndrome: A real life version of Lewis Carroll's novel". Brain & Development. 39 (6): 470–474. doi:10.1016/j.braindev.2017.01.004. PMID 28189272.
^ ^a ^b ^c ^d ^e ^f Farooq O, Fine EJ (December 2017). "Alice in Wonderland Syndrome: A Historical and Medical Review". Pediatric Neurology. 77: 5–11. doi:10.1016/j.pediatrneurol.2017.08.008. PMID 29074056.
^ Weissenstein, Anne; Luchter, Elisabeth; Bittmann, M.A. Stefan (2014). "Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child". Journal of Pediatric Neurosciences. 9 (3): 303–304. doi:10.4103/1817-1745.147612. ISSN 1817-1745. PMC 4302569. PMID 25624952.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ Craighead WE, Nemeroff CB, eds. (2004). "Hallucinations". The Concise Corsini Encyclopedia of Psychology and Behavioral Science. Hoboken: Wiley. ISBN 978-0-471-22036-7.
^ "Alice in Wonderland syndrome". Mosby's Dictionary of Medicine, Nursing & Health Professions. Philadelphia: Elsevier Health Sciences. 2009. ISBN 978-0-323-22205-1.
^ "Micropsia". Mosby's Emergency Dictionary. Philadelphia: Elsevier Health Sciences. 1998.
^ "Macropsia". Collins English Dictionary. London: Collins. 2000. ISBN 978-0-00-752274-3. Archived from the original on 2018-01-07.
^ Palacios-Sánchez, Leonardo; Botero-Meneses, Juan Sebastián; Mora-Muñoz, Laura; Guerrero-Naranjo, Alejandro; Moreno-Matson, María Carolina; Pachón, Natalia; Charry-Sánchez, Jesús David (2018-04). "Alice in Wonderland Syndrome (AIWS). A reflection". Colombian Journal of Anesthesiology. 46 (2): 143–147. doi:10.1097/CJ9.0000000000000026. ISSN 2256-2087. {{cite journal}}: Check date values in: |date= (help)
^ Ffytche DH (2007-06-07). "Visual hallucinatory syndromes: past, present, and future". Dialogues in Clinical Neuroscience. 9 (2): 173–89. PMC 3181850. PMID 17726916.
^ Platz WE, Oberlaender FA, Seidel ML (1995). "The phenomenology of perceptual hallucinations in alcohol-induced delirium tremens". Psychopathology. 28 (5): 247–55. doi:10.1159/000284935. PMID 8559948.
^ "What Is Alice in Wonderland Syndrome?". WebMD. Retrieved 2018-09-06.
^ Hemsley R (2017-09-13). "Alice in Wonderland Syndrome". aiws.info. Archived from the original on 2017-09-14. Retrieved 2017-09-13.
^ ^a ^b Farooq O, Fine EJ (December 2017). "Alice in Wonderland Syndrome: A Historical and Medical Review". Pediatric Neurology. 77: 5–11. doi:10.1016/j.pediatrneurol.2017.08.008. PMID 29074056.
^ Liu, Alessandra M.; Liu, Jonathan G.; Liu, Geraldine W.; Liu, Grant T. (2014). ""Alice in Wonderland" Syndrome: Presenting and Follow-Up Characteristics". Pediatric Neurology. 51 (3): 317–320. doi:10.1016/j.pediatrneurol.2014.04.007. ISSN 0887-8994.
^ Cinbis M, Aysun S (May 1992). "Alice in Wonderland syndrome as an initial manifestation of Epstein-Barr virus infection". The British Journal of Ophthalmology. 76 (5): 316. doi:10.1136/bjo.76.5.316. PMC 504267. PMID 1390519.
^ Eshel, Lahat (1991). ""Alice in Wonderland" syndrome: a manifestation of infectious mononucleosis in children". Behavioural Neurology. 4 (3): 163–166. doi:10.3233/BEN-1991-4304. PMID 24487499.
^ "Alice in Wonderland syndrome". Taber's Cyclopedic Medical Dictionary. Philadelphia: F. A. Davis Company. 2009. ISBN 978-0-8036-2325-5.
^ ^a ^b ^c Mastria G, Mancini V, Viganò A, Di Piero V (2016). "Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review". BioMed Research International. 2016: 8243145. doi:10.1155/2016/8243145. PMC 5223006. PMID 28116304.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ Perez-Garcia, Luis; Pacheco, Oriana; Delgado-Noguera, Lourdes; Motezuma, Jean Pilade M.; Sordillo, Emilia M.; Paniz Mondolfi, Alberto E (2021). "Infectious causes of Alice in Wonderland syndrome". Journal of NeuroVirology. doi:10.1007/s13365-021-00988-8. ISSN 1538-2443.
^ Kuo, Shin-Chang; Yeh, Yi-Wei; Chen, Chun-Yen; Weng, Ju-Ping; Tzeng, Nian-Sheng (2012-07-01). "Possible Association Between Alice In Wonderland Syndrome And Influenza A Infection". The Journal of Neuropsychiatry and Clinical Neurosciences. 24 (3): E7–E8. doi:10.1176/appi.neuropsych.11080177. ISSN 0895-0172.
^ Kuo YT, Chiu NC, Shen EY, Ho CS, Wu MC (August 1998). "Cerebral perfusion in children with Alice in Wonderland syndrome". Pediatric Neurology. 19 (2): 105–8. doi:10.1016/s0887-8994(98)00037-x. PMID 9744628.
^ Weissenstein, Anne; Luchter, Elisabeth; Bittmann, M.A. Stefan (2014). "Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child". Journal of Pediatric Neurosciences. 9 (3): 303–304. doi:10.4103/1817-1745.147612. ISSN 1817-1745. PMC 4302569. PMID 25624952.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ Jürgens, T. P.; Ihle, K.; Stork, J.-H.; May, A. (2011-02-01). ""Alice in Wonderland syndrome" associated with topiramate for migraine prevention". Journal of Neurology, Neurosurgery & Psychiatry. 82 (2): 228–229. doi:10.1136/jnnp.2009.187245. ISSN 0022-3050. PMID 20571045.
^ ^a ^b ^c O'Toole P, Modestino EJ (June 2017). "Alice in Wonderland Syndrome: A real life version of Lewis Carroll's novel". Brain & Development. 39 (6): 470–474. doi:10.1016/j.braindev.2017.01.004. PMID 28189272.
^ Liu, Alessandra M.; Liu, Jonathan G.; Liu, Geraldine W.; Liu, Grant T. (2014). ""Alice in Wonderland" Syndrome: Presenting and Follow-Up Characteristics". Pediatric Neurology. 51 (3): 317–320. doi:10.1016/j.pediatrneurol.2014.04.007. ISSN 0887-8994.
^ Blom, Jan Dirk (2016). "Alice in Wonderland syndrome: A systematic review". Neurology: Clinical Practice. 6 (3): 259–270. doi:10.1212/CPJ.0000000000000251. ISSN 2163-0402. PMC 4909520. PMID 27347442.
^ Liu, Alessandra M.; Liu, Jonathan G.; Liu, Geraldine W.; Liu, Grant T. (2014). ""Alice in Wonderland" Syndrome: Presenting and Follow-Up Characteristics". Pediatric Neurology. 51 (3): 317–320. doi:10.1016/j.pediatrneurol.2014.04.007. ISSN 0887-8994.
^ Blom, Jan Dirk (2016). "Alice in Wonderland syndrome". Neurology: Clinical Practice. 6 (3): 259–270. doi:10.1212/CPJ.0000000000000251. ISSN 2163-0402. PMC 4909520. PMID 27347442.
^ Abe K, Oda N, Araki R, Igata M (July 1989). "Macropsia, micropsia, and episodic illusions in Japanese adolescents". Journal of the American Academy of Child and Adolescent Psychiatry. 28 (4): 493–6. doi:10.1097/00004583-198907000-00004. PMID 2788641.
^ Weissenstein A, Luchter E, Bittmann MA (2014). "Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child". Journal of Pediatric Neurosciences. 9 (3): 303–4. doi:10.4103/1817-1745.147612. PMC 4302569. PMID 25624952.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ Todd J (November 1955). "The syndrome of Alice in Wonderland". Canadian Medical Association Journal. 73 (9): 701–4. PMC 1826192. PMID 13304769.
^ Lanska JR, Lanska DJ (March 2013). "Alice in Wonderland Syndrome: somesthetic vs visual perceptual disturbance". Neurology. 80 (13): 1262–4. doi:10.1212/WNL.0b013e31828970ae. PMID 23446681.
^ "The Career of Dr John Todd And Drug Addiction Case Studies". Highroydshospital.com. Archived from the original on 2014-06-07. Retrieved 2014-06-04.
^ Cau C (October 1999). "La sindrome di Alice nel paese delle meraviglie" [The Alice in Wonderland syndrome]. Minerva Medica (in Italian). 90 (10): 397–401. PMID 10767914.
^ Martin R. "Through the Looking Glass, Another Look at Migraine" (PDF). Archived (PDF) from the original on 2013-09-21. Retrieved 2013-09-15.
^ Chand PK, Murthy P. "Understanding a Strange Phenomenon: Lilliputian Hallucinations". German Journal of Psychiatry. Archived from the original on 2009-01-23. Retrieved 2009-10-25.
^ "Medical Definition of Lilliputian hallucination". MedicineNet. Retrieved August 16, 2018.
^ Martin R. "Through the Looking Glass, Another Look at Migraine" (PDF). Archived (PDF) from the original on 2013-09-21. Retrieved 2013-09-15.
^ Angier N (1993-10-12). "In the Temporal Lobes, Seizures and Creativity". The New York Times. ISSN 0362-4331. Archived from the original on 2017-09-13. Retrieved 2017-09-13.
^ Writer: Lisa McMullin; Director: Daniel Wilson; Producer: Peter Leslie Wild (7 April 2020). "Al Through the Looking Glass". Doctors. BBC. BBC One.

External links

[oxford-1] Longmore M, Wilkinson I, Turmezei T, Cheung CK (2007). Oxford Handbook of Clinical Medicine. Oxford. p. 686. ISBN 978-0-19-856837-7.

[2] "Alice and Wonderland Syndrome and Visual Migraines".

[3] "Alice in Wonderland Syndrome | Symptoms & Treatment". Share.upmc.com. 2016-10-25. Retrieved 2019-08-30.

[4] Cinbis M, Aysun S (May 1992). "Alice in Wonderland syndrome as an initial manifestation of Epstein-Barr virus infection". Br J Ophthalmol. 76 (5): 314. doi:10.1136/bjo.76.5.316. PMC 504267. PMID 1390519.

[Feldman2008-5] Feldman, Caroline (April 7, 2008). "A Not So Pleasant Fairy Tale: Investigating Alice in Wonderland Syndrome". Serendip. Serendip Studio, Bryn Mawr College. Archived from the original on November 9, 2008. Retrieved 25 November 2011.

[:3-6] Lanska, Douglas J.; Lanska, John R. (2018), Bogousslavsky, J. (ed.), "The Alice-in-Wonderland Syndrome", Frontiers of Neurology and Neuroscience, vol. 42, S. Karger AG, pp. 142–150, doi:10.1159/000475722, ISBN 978-3-318-06088-1, retrieved 2021-07-27

[7] Stapinski H (23 June 2014). "I Had Alice in Wonderland Syndrome". The New York Times. Archived from the original on 6 September 2015.

[:1-8] O'Toole P, Modestino EJ (June 2017). "Alice in Wonderland Syndrome: A real life version of Lewis Carroll's novel". Brain & Development. 39 (6): 470–474. doi:10.1016/j.braindev.2017.01.004. PMID 28189272.

[:0-9] ^ ^a ^b ^c ^d ^e ^f Farooq O, Fine EJ (December 2017). "Alice in Wonderland Syndrome: A Historical and Medical Review". Pediatric Neurology. 77: 5–11. doi:10.1016/j.pediatrneurol.2017.08.008. PMID 29074056.

[10] Weissenstein, Anne; Luchter, Elisabeth; Bittmann, M.A. Stefan (2014). "Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child". Journal of Pediatric Neurosciences. 9 (3): 303–304. doi:10.4103/1817-1745.147612. ISSN 1817-1745. PMC 4302569. PMID 25624952.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[11] Craighead WE, Nemeroff CB, eds. (2004). "Hallucinations". The Concise Corsini Encyclopedia of Psychology and Behavioral Science. Hoboken: Wiley. ISBN 978-0-471-22036-7.

[12] "Alice in Wonderland syndrome". Mosby's Dictionary of Medicine, Nursing & Health Professions. Philadelphia: Elsevier Health Sciences. 2009. ISBN 978-0-323-22205-1.

[13] "Micropsia". Mosby's Emergency Dictionary. Philadelphia: Elsevier Health Sciences. 1998.

[14] "Macropsia". Collins English Dictionary. London: Collins. 2000. ISBN 978-0-00-752274-3. Archived from the original on 2018-01-07.

[15] Palacios-Sánchez, Leonardo; Botero-Meneses, Juan Sebastián; Mora-Muñoz, Laura; Guerrero-Naranjo, Alejandro; Moreno-Matson, María Carolina; Pachón, Natalia; Charry-Sánchez, Jesús David (2018-04). "Alice in Wonderland Syndrome (AIWS). A reflection". Colombian Journal of Anesthesiology. 46 (2): 143–147. doi:10.1097/CJ9.0000000000000026. ISSN 2256-2087. {{cite journal}}: Check date values in: |date= (help)

[16] Ffytche DH (2007-06-07). "Visual hallucinatory syndromes: past, present, and future". Dialogues in Clinical Neuroscience. 9 (2): 173–89. PMC 3181850. PMID 17726916.

[17] Platz WE, Oberlaender FA, Seidel ML (1995). "The phenomenology of perceptual hallucinations in alcohol-induced delirium tremens". Psychopathology. 28 (5): 247–55. doi:10.1159/000284935. PMID 8559948.

[18] "What Is Alice in Wonderland Syndrome?". WebMD. Retrieved 2018-09-06.

[19] Hemsley R (2017-09-13). "Alice in Wonderland Syndrome". aiws.info. Archived from the original on 2017-09-14. Retrieved 2017-09-13.

[:03-20] Farooq O, Fine EJ (December 2017). "Alice in Wonderland Syndrome: A Historical and Medical Review". Pediatric Neurology. 77: 5–11. doi:10.1016/j.pediatrneurol.2017.08.008. PMID 29074056.

[21] Liu, Alessandra M.; Liu, Jonathan G.; Liu, Geraldine W.; Liu, Grant T. (2014). ""Alice in Wonderland" Syndrome: Presenting and Follow-Up Characteristics". Pediatric Neurology. 51 (3): 317–320. doi:10.1016/j.pediatrneurol.2014.04.007. ISSN 0887-8994.

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@@ Line 37: / Line 37: @@
 ==Signs and symptoms==
-Alice in Wonderland syndrome affects the sense of vision, sensation, touch, and hearing, as well as the perception of one's own body image.<ref>{{Cite journal|last=Stapinski|first=Helene|name-list-style=vanc|title=I Had Alice in Wonderland Syndrome|url=http://well.blogs.nytimes.com/2014/06/23/alice-in-wonderland-syndrome/|date=23 June 2014|journal=The New York Times|url-status=live|archive-url=https://web.archive.org/web/20150906085138/http://well.blogs.nytimes.com/2014/06/23/alice-in-wonderland-syndrome/|archive-date=6 September 2015}}</ref> Migraines, nausea, dizziness, and agitation are also commonly associated symptoms with Alice in Wonderland syndrome.<ref name=":1" />  Less frequent symptoms also include loss of limb control and coordination, memory loss, lingering touch and sound sensations, and emotional instability.<ref name=":0" /> Alice in Wonderland syndrome is characterized by the individual being able to recognize the distortion in the perception of their own body<ref>{{Cite journal|last=Weissenstein|first=Anne|last2=Luchter|first2=Elisabeth|last3=Bittmann|first3=M.A. Stefan|date=2014|title=Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302569/|journal=Journal of Pediatric Neurosciences|volume=9|issue=3|pages=303–304|doi=10.4103/1817-1745.147612|issn=1817-1745|pmc=4302569|pmid=25624952}}</ref>.
+Alice in Wonderland syndrome affects the sense of vision, sensation, touch, and hearing, as well as the perception of one's own body image.<ref>{{Cite journal|last=Stapinski|first=Helene|name-list-style=vanc|title=I Had Alice in Wonderland Syndrome|url=http://well.blogs.nytimes.com/2014/06/23/alice-in-wonderland-syndrome/|date=23 June 2014|journal=The New York Times|url-status=live|archive-url=https://web.archive.org/web/20150906085138/http://well.blogs.nytimes.com/2014/06/23/alice-in-wonderland-syndrome/|archive-date=6 September 2015}}</ref> Migraines, nausea, dizziness, and agitation are also commonly associated symptoms with Alice in Wonderland syndrome.<ref name=":1" />  Less frequent symptoms also include loss of limb control and coordination, memory loss, lingering touch and sound sensations, and emotional instability.<ref name=":0" /> Alice in Wonderland syndrome is characterized by the individual being able to recognize the distortion in the perception of their own body<ref>{{Cite journal|last=Weissenstein|first=Anne|last2=Luchter|first2=Elisabeth|last3=Bittmann|first3=M.A. Stefan|date=2014|title=Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302569/|journal=Journal of Pediatric Neurosciences|volume=9|issue=3|pages=303–304|doi=10.4103/1817-1745.147612|issn=1817-1745|pmc=4302569|pmid=25624952}}</ref> and is episodic in nature.
 === Visual distortions ===
@@ Line 44: / Line 44: @@
 Within the category of Lilliputian hallucinations, people may experience either micropsia or macropsia.  Micropsia is an abnormal visual condition, usually occurring in the context of [[visual hallucination]], in which the affected person sees objects as being smaller than they are in reality.<ref>{{cite book | chapter = Micropsia | title = Mosby's Emergency Dictionary | location = Philadelphia | publisher = Elsevier Health Sciences | year = 1998 }}</ref> Macropsia is a condition where the individual sees everything larger than it actually is.<ref>{{cite book | chapter = Macropsia | chapter-url = https://www.collinsdictionary.com/dictionary/english/macropsia | title = Collins English Dictionary | location = London | publisher = Collins | year = 2000 | isbn = 978-0-00-752274-3 | url-status = live | archive-url = https://web.archive.org/web/20180107175120/https://www.collinsdictionary.com/dictionary/english/macropsia | archive-date = 2018-01-07 }}</ref>
+Alice in Wonderland syndrome episodes vary in length from person to person. Episodes typically last from a few minutes to an hour, and each episode may vary in experience<ref>{{Cite journal|last=Palacios-Sánchez|first=Leonardo|last2=Botero-Meneses|first2=Juan Sebastián|last3=Mora-Muñoz|first3=Laura|last4=Guerrero-Naranjo|first4=Alejandro|last5=Moreno-Matson|first5=María Carolina|last6=Pachón|first6=Natalia|last7=Charry-Sánchez|first7=Jesús David|date=2018-04|title=Alice in Wonderland Syndrome (AIWS). A reflection|url=https://journals.lww.com/rca/fulltext/2018/06000/alice_in_wonderland_syndrome__aiws___a_reflection.9.aspx|journal=Colombian Journal of Anesthesiology|language=en-US|volume=46|issue=2|pages=143–147|doi=10.1097/CJ9.0000000000000026|issn=2256-2087}}</ref>.
-One 17-year-old boy described his odd symptoms by the following: "Quite suddenly objects appear small and distant or large and close. I feel as [if] I am getting shorter and smaller 'shrinking' and also the size of persons are not longer than my index finger (a lilliputian proportion). Sometimes I see the blind in the window or the television getting up and down, or my leg or arm is swinging. I may hear the voices of people quite loud and close or faint and far. Occasionally, I experience attacks of migrainous headache associated with eye redness, flashes of lights and a feeling of giddiness. I am always conscious to the intangible changes in myself and my environment".<ref name="BMC Neurology">{{cite journal | vauthors = Hamed SA | title = A migraine variant with abdominal colic and Alice in Wonderland syndrome: a case report and review | journal = BMC Neurology | volume = 10 | page = 2 | date = January 2010 | pmid = 20053267 | doi = 10.1186/1471-2377-10-2 | pmc = 2817660 }}</ref>
-Although a person's vision of real versus hallucinatory objects is not affected, they will often 'see' objects as the incorrect size, shape or perspective angle. Therefore, people, cars, buildings, houses, animals, trees, environments, etc., look smaller or larger than they should be. Further, depth perception can be altered whereby perceived distances are incorrect. For example, a corridor may appear to be very long, or the ground may appear too close.<ref name=":0" /><ref name="autogenerated1262">{{cite journal | vauthors = Lanska JR, Lanska DJ | title = Alice in Wonderland Syndrome: somesthetic vs visual perceptual disturbance | journal = Neurology | volume = 80 | issue = 13 | pages = 1262–4 | date = March 2013 | pmid = 23446681 | doi = 10.1212/WNL.0b013e31828970ae }}</ref>
 === Hallucinations ===
@@ Line 101: / Line 99: @@
 ==History==
-The syndrome is sometimes called Todd's syndrome, in reference to an influential description of the condition in 1955 by Dr. John Todd (1914–1987), a British consultant psychiatrist at [[High Royds Hospital]] at [[Menston]] in [[West Yorkshire]].<ref>{{cite journal | vauthors = Todd J | title = The syndrome of Alice in Wonderland | journal = Canadian Medical Association Journal | volume = 73 | issue = 9 | pages = 701–4 | date = November 1955 | pmid = 13304769 | pmc = 1826192 }}</ref><ref name="autogenerated1262"/><ref>{{cite web |url=http://www.highroydshospital.com/galleries/the-career-of-dr-john-todd-and-drug-addiction-case-studies/ |title=The Career of Dr John Todd And Drug Addiction Case Studies |publisher=Highroydshospital.com |access-date=2014-06-04 |url-status=live |archive-url=https://web.archive.org/web/20140607001654/http://www.highroydshospital.com/galleries/the-career-of-dr-john-todd-and-drug-addiction-case-studies/ |archive-date=2014-06-07 }}</ref>  Dr. Todd discovered that several of his patients experienced severe headaches causing them to see and perceive objects as greatly out of proportion. In addition, they had altered sense of time and touch, as well as [[Body dysmorphic disorder|distorted perceptions]] of their own body. Despite having migraine headaches, none of these patients had brain tumors, damaged eyesight, or mental illness that could have accounted for these and similar symptoms. They were also all able to think lucidly and could distinguish hallucinations from reality, however, their perceptions were distorted.<ref>{{cite journal | vauthors = Cau C | title = La sindrome di Alice nel paese delle meraviglie | trans-title = The Alice in Wonderland syndrome | language = it | journal = Minerva Medica | volume = 90 | issue = 10 | pages = 397–401 | date = October 1999 | pmid = 10767914 | url = https://www.minervamedica.it/it/riviste/minerva-medica/articolo.php?cod=R10Y1999N10A0397 }}</ref>
+The syndrome is sometimes called Todd's syndrome, in reference to an influential description of the condition in 1955 by Dr. John Todd (1914–1987), a British consultant psychiatrist at [[High Royds Hospital]] at [[Menston]] in [[West Yorkshire]].<ref>{{cite journal | vauthors = Todd J | title = The syndrome of Alice in Wonderland | journal = Canadian Medical Association Journal | volume = 73 | issue = 9 | pages = 701–4 | date = November 1955 | pmid = 13304769 | pmc = 1826192 }}</ref><ref name="autogenerated1262">{{cite journal|vauthors=Lanska JR, Lanska DJ|date=March 2013|title=Alice in Wonderland Syndrome: somesthetic vs visual perceptual disturbance|journal=Neurology|volume=80|issue=13|pages=1262–4|doi=10.1212/WNL.0b013e31828970ae|pmid=23446681}}</ref><ref>{{cite web |url=http://www.highroydshospital.com/galleries/the-career-of-dr-john-todd-and-drug-addiction-case-studies/ |title=The Career of Dr John Todd And Drug Addiction Case Studies |publisher=Highroydshospital.com |access-date=2014-06-04 |url-status=live |archive-url=https://web.archive.org/web/20140607001654/http://www.highroydshospital.com/galleries/the-career-of-dr-john-todd-and-drug-addiction-case-studies/ |archive-date=2014-06-07 }}</ref>  Dr. Todd discovered that several of his patients experienced severe headaches causing them to see and perceive objects as greatly out of proportion. In addition, they had altered sense of time and touch, as well as [[Body dysmorphic disorder|distorted perceptions]] of their own body. Despite having migraine headaches, none of these patients had brain tumors, damaged eyesight, or mental illness that could have accounted for these and similar symptoms. They were also all able to think lucidly and could distinguish hallucinations from reality, however, their perceptions were distorted.<ref>{{cite journal | vauthors = Cau C | title = La sindrome di Alice nel paese delle meraviglie | trans-title = The Alice in Wonderland syndrome | language = it | journal = Minerva Medica | volume = 90 | issue = 10 | pages = 397–401 | date = October 1999 | pmid = 10767914 | url = https://www.minervamedica.it/it/riviste/minerva-medica/articolo.php?cod=R10Y1999N10A0397 }}</ref>
 Since Lewis Carroll had been a well-known migraine sufferer with similar symptoms, Dr. Todd speculated that Carroll had used his own migraine experiences as a source of inspiration for his famous 1865 novel ''Alice's Adventures in Wonderland''. Carroll's diary reveals that in 1856 he consulted William Bowman, an eminent [[ophthalmologist]], about the visual manifestations of the migraines he regularly experienced.<ref>{{cite web | last = Martin | first = R | name-list-style = vanc | title = Through the Looking Glass, Another Look at Migraine | url = http://lenus.ie/hse/bitstream/10147/128190/1/Article6086.pdf | access-date = 2013-09-15 | url-status = live | archive-url = https://web.archive.org/web/20130921054427/http://lenus.ie/hse/bitstream/10147/128190/1/Article6086.pdf | archive-date = 2013-09-21 }}</ref>