Alice in Wonderland Syndrome.
Yes, just like the book
Have you ever watched the classic Disney movie ‘Alice in Wonderland’? The film is based on the 1865 story ‘Alice’s Adventures in Wonderland’ by Lewis Carroll, about a young girl who falls through a rabbit hole, entering a world of anthropomorphic creatures. Alice stumbles upon a tiny door that she is too big to go through when in the rabbit hole. After this, she finds a bottle that says, “Drink me”. Following the instructions, Alice drinks the bottle and begins to shrink literally.
Unfortunately for her, the key to the door was on the table that she could no longer reach. She discovers and eats a cake that makes her grow into a giant. Long story short, the plot features a plethora of unusual instances, characters, and imagery that one of us real humans can experience by taking in a psychedelic. At the end of the story, Alice is awoken from her slumber by her sister, revealing that the entire plot is just a really trippy dream.
Let’s rewind the plot. Remember how Alice shrunk and grew after consuming a drink and cake, respectively? This aspect of the story inspires Dr. John Todd to name a condition he witnessed as Alice in Wonderland Syndrome (AIWS). Dr. Todd found several of his patients experiencing migraines that lead to disproportionate perceptions of objects, altered sense of time and touch, as well as distorted perception of their bodies. Such a discovery was only met with further bewilderment as the patients lacked any brain tumors, damaged eyesight, or mental illnesses.
Furthermore, the patients understood they were hallucinating and could distinguish between hallucinations and reality. Dr. Todd figured that Carroll had used his experiences with migraines to inspire Alice’s Adventures in Wonderland. Carroll’s diaries have also contained multiple mentions of a “bilious headache”, followed by optical distortions at times. Such cases have been reported before Dr. Todd’s findings, too, with Dr. William Spratling being the first in recorded literature to report metamorphopsias¹ associated with migraine, followed by numerous more recounts of similar symptoms after, including a substantial amount during the two World Wars. However, Dr Todd’s findings are the most influential on current knowledge of the disorder.
Symptoms tend to affect both their self-perception, such as distorted views of their body parts, primarily their head and hands, as well as their visual perception, with common ones being objects appearing to be sized differently, at a different distance from the individual, as well as their overall appearance too. There have been instances where patients saw a shortened arm attached to the face of the person in front of them. These distortions often continue to affect other objects around the affected, such as buildings and furniture. AIWS symptoms often accompany migraines, with the pain and unusual sights leading to people losing the sense of time and reality, including occasional cases of intense hallucinations. As the patient’s visual experiences warp around them, their auditory and tactile experiences tend to get affected, too.
A diagnosis of AIWS is uncommon, as not many clinicians are aware of its existence due to the ambiguity of its diagnostics. Although no definitive cause is identified behind AIWS, standard auxiliary investigations such as blood tests, EEG², and MRIs are strongly advised to identify any underlying conditions that may contribute to the onset of the disorder. Migraines, as mentioned before, are believed to be the most common causes and can act alongside migraine auras³. Brain tumors, both benign and malignant, are not too far behind migraines as being a common cause for symptoms. It is also believed that some who experience seizures or certain types of strokes that disrupt cerebral circulation can, too, experience AIWS. Predictably, the intake of psychoactive drugs may also contribute to experiencing the symptoms of the disorder. Recently, doctors presented with patients experiencing AIWS symptoms have begun looking for an Epstein-Barr virus⁴ infection, as there have been links identified between the infection and the disorder. There have been cases suggesting other possible biological reasons behind the onset of AIWS, such as
- Lyme disease⁵
- Creutzfeldt-Jakob disease⁶
- mononucleosis⁷
- coxsackievirus⁸
- scarlet fever⁹
- and H1N1-influenza¹⁰
Researchers that report the aforementioned cases, although they feature singular or significantly minute samples, have not been ruled out due to the rarity, the lack of greater attention given to them, and the lack of research conducted on the condition. It is worth noting that this disorder is more prevalent among children, with the average age for patients being 15.5 years old among 166 AIWS patients mentioned across PubMed (as of June 2016). One must also keep in mind that AIWS is usually short-lived.
The treatment of AIWS is just as ambiguous as its diagnostic criteria. Whatever causes it, you treat that. As migraines are described as the most common causes of the condition, migraine prevention, such as anticonvulsant and beta blockers, are general treatments. Other treatments include anti-epileptics, antivirals, and antibiotics, depending on the symptoms’ underlying cause.
Remember that the symptoms of AIWS, mainly, are not that rare. However, a diagnosis of AIWS is. A 1989 study conducted in Japan among 3224 high-school students aged 13–18 years old reports that about 9% of the students claimed to have experienced one or more micropsia¹¹, macropsia¹², and distortions of time perception. The ICD-11 and DSM-5 do not classify the disorder among their systems due to their lack of standard diagnostic criteria. Diagnosing the condition is unlikely to get any easier as it is temporary and cannot be treated directly.
- A SECONDARY RESEARCH ARTICLE BY SAMYAK MAHAPATRA -
[1] metamorphopsia is a syndrome in which the shape of objects appears distorted
[2] electroencephalography — a scan of brain waves
[3] sensory disturbances preceding migraines, such as flashes of lights, blind spots, and tingles in extremities
[4] a highly contagious virus that spreads through bodily fluids. Some infections can lead to mononucleosis and very rare cases, cancer
[5] an infectious disease caused by Borrelia burgdorferi, which is spread by ticks
[6] rapidly progressive, rare, transmissible, universally fatal, neurodegenerative condition caused by prion proteins — proteins that can trigger normal proteins in the brain to fold abnormally
[7] a highly contagious infection characterised by pharyngitis, cervical lymph node enlargement, fatigue, and fever, which results most often from an Epstein–Barr virus infection
[8] a virus that presents with mild flu-like symptoms but can cause more severe infections such as encephalitis (brain infection) or meningitis (infection of the membrane surrounding the brain and spinal cord)
[9] a contagious infection that presents as a flu-like fever and, more distinctly, a rash that makes the skin feel like sandpaper
[10] aka, swine flu. Causes upper and sometimes lower respiratory tract infections. most common infection in pigs
[11] seeing objects as a smaller size than what they indeed are
[12] seeing objects as a bigger size than what they indeed are
