Alice in Wonderland syndrome

At first glance, the fairy-tale term "Alice in Wonderland syndrome" refers to a not so harmless disease, which, fortunately, is extremely rare. The disease is a neurological disorder in which reality is distorted. The patient perceives the world as if in a fairy tale: surrounding objects take on unnaturally large or small sizes, distances and boundaries are distorted. The visual picture becomes like a "crooked mirror".

What causes this syndrome? Can it be cured?

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Epidemiology

Alice in Wonderland syndrome is diagnosed mainly in childhood – between 5 and 13 years of age. However, the development of the disease in adult patients – after 20-25 years of age – is not excluded.

The disease is not considered chronic. In most cases, the syndrome is transient, manifesting itself temporarily and periodically. However, there are several cases where the symptoms of the disease did not leave patients for many years.

Alice in Wonderland syndrome is considered a very rare disorder. For example, according to American statistics, no more than three hundred Americans currently suffer from it.

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Causes of Alice in Wonderland syndrome

Scientists have identified a number of reasons that can lead to the appearance of Alice in Wonderland syndrome:

• frequent migraine attacks, with prolonged and debilitating pain in the head;
• schizophrenia is a mental disorder accompanied by thought disorders, hallucinations, and distorted perception of the surrounding space;
• infectious mononucleosis, which affects various parts of the brain;
• epileptic seizures accompanied by hallucinogenic states;
• malignant neoplasms in the brain.

When diagnosing Alice's syndrome, one should also take into account such risk factors as the use of psychotropic and hallucinogenic drugs, substance abuse, drug addiction, smoking marijuana, hashish, marijuana, as well as frequent and profound stressful situations, excessive suspiciousness and susceptibility of a person, and lability of the nervous system.

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Pathogenesis

The nature of Alice in Wonderland syndrome has not yet been fully elucidated. It is generally accepted that the disease is preceded by various exogenous factors, which can be divided into two groups:

• organic influences on the functioning of the brain – consequences of injuries, poisoning, infectious diseases, radiation, etc.;
• psycho-emotional impacts – conflicts (both with others and with oneself), stress, unfavorable social influence.

Sometimes several factors may influence each other. The main one is considered to be the one that determines the onset of the disease and its dynamic development.

Currently, the mechanism of development of the pathological process is under consideration, since Alice in Wonderland syndrome is considered a rare pathology.

Symptoms of Alice in Wonderland syndrome

Alice in Wonderland syndrome occurs in the form of attacks that can last from less than one minute to several days (according to some descriptions, even about a month).

The first signs of an attack of Alice's syndrome:

• surrounding objects suddenly increase or decrease significantly in size;
• the distance between objects decreases or increases;
• the proportions of objects change.

In almost all cases, the patient perceives the visible picture as real, that is, identifying it with real time. At the same time, the person may lose orientation in space, become very scared (up to the development of a phobia).

Externally, the attack is accompanied by the following symptoms:

• tachycardia;
• frequent, agitated breathing;
• signs of a growing panic attack.

In some patients, the first sign of an attack of Alice syndrome is a headache (migraine-like headache).

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Stages

An attack of Alice in Wonderland syndrome can proceed in different ways: this refers to both the duration and clinical manifestations of the attack. Due to such differences, it is customary to distinguish three fundamental stages:

• the initial stage of an attack - may begin with a headache or general anxiety, with a gradual or rapid increase in symptoms;
• the main stage of an attack is the most active phase of manifestation of clinical symptoms;
• The final stage is the phase when the symptoms of the attack subside.

During the final stage, patients may notice sudden fatigue, apathy, indifference and drowsiness.

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Forms

There are two clinical types of Alice in Wonderland syndrome:

• Macropsia (giant hallucinations) – in this condition, the patient has the feeling that surrounding objects have suddenly and greatly increased in size.
• Micropsia (dwarf hallucinations) – the patient perceives surrounding objects as the opposite of macropsia, that is, as too small.

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Complications and consequences

The consequences of Alice in Wonderland syndrome can be different, but they can all be divided into two types - these are the consequences of a psychological and social nature.

The psychological consequences are that the patient unconsciously expects and fears a repeat of the attack. In connection with this, he withdraws into himself, avoids communication, tries not to leave the house and not to visit crowded places.

Repeated attacks of Alice in Wonderland syndrome can lead to the development of long-term depression, weakened concentration, and even a feeling of hopelessness. Complex and prolonged attacks can lead to loss of ability to work, to personal and social problems. Often the patient becomes the object of ridicule and misunderstanding from others, and even close people.

Against the background of constant sluggish depression and a depressed state, various somatic diseases can develop. The cardiovascular, nervous and digestive systems suffer to a greater extent.

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Diagnostics of Alice in Wonderland syndrome

The diagnosis of Alice in Wonderland syndrome is made based on information received from the patient. For example, the doctor will definitely ask the patient the following questions:

• When did the first attack of the syndrome appear?
• How long did it last?
• What exactly did the patient feel during the attack?
• What does the patient associate the onset of the attack with?
• Have similar attacks recurred? If so, how often?

Since Alice in Wonderland syndrome is a fairly specific condition, laboratory and instrumental diagnostics are often not used due to their low information content.

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Differential diagnosis

However, for differential diagnosis it is possible to use CT, electroencephalography, lumbar puncture with fluid analysis.

Additionally, the doctor conducts a neurological examination, which is especially informative during an attack of Alice syndrome. Symptoms such as tachycardia, increased blood pressure, frequent breathing movements, and general anxiety may be detected. If necessary, a consultation with a psychoneuropathologist, narcologist, or therapist is prescribed.

Differential diagnostics can be carried out with the following diseases and conditions:

• panic attacks;
• drug, alcohol or other psychotropic intoxication;
• feverish state with delirious syndrome.

Treatment of Alice in Wonderland syndrome

Treatment for Alice in Wonderland syndrome is prescribed individually. If the doctor can determine the cause of the disease, then the treatment is aimed at eliminating this cause, as well as alleviating painful symptoms. Thus, for epilepsy, anticonvulsants and relaxants are prescribed, for migraines - analgesics and sedatives, etc.

To extend the period between attacks, the patient is recommended to undergo a course of sessions with a psychotherapist or psychologist. Such sessions reduce the severity of fears and bring out of depressive states.

A special place in the rehabilitation of patients with Alice in Wonderland syndrome is the support of family and relatives. It is undesirable to leave a sick person (especially a child) alone with himself.

Hypnosis sessions and cognitive behavioral therapy can have a good therapeutic effect.

Medicines

Medicines are prescribed to reduce the severity of symptoms during attacks of Alice in Wonderland syndrome. The doctor may use the following drugs:

• sedatives – Persen, Tenoten, valerian extract;
• antidepressants - Amitriptyline, Prozac;
• benzodiazepines – Clobazam, Chlordiazepoxide;
• nootropic drugs – Glycine, Pyritinol, Piracetam.

	Method of administration and dosage	Side effects	Special instructions
Persen	Take 2-3 tablets orally up to 3 times a day. The maximum daily dosage is 12 tablets.	Allergies, constipation, and bronchospasm may occur.	Persen is not recommended for long-term use, more than 2 months.

	Method of administration and dosage	Side effects	Special instructions
Prozac	The drug is taken from 20 to 60 mg/day, regardless of food intake.	Dyspepsia, nervousness, ataxia, decreased libido, frequent urination, and allergies are possible.	If the patient is diagnosed with epilepsy, Prozac is prescribed with special caution.

	Method of administration and dosage	Side effects	Special instructions
Clobazam	Take from 5 to 15 mg per day, with a possible gradual increase in dosage to 50 mg per day.	May cause drowsiness, allergies, ataxia.	Clobazam can cause drug dependence, so taking the drug for more than 4 weeks in a row is not recommended.

	Method of administration and dosage	Side effects	Special instructions
Piracetam	Take from 30 to 160 mg per kg of weight per day. The dosage is divided into 2-4 doses. The course of therapy can be 1.5-2 months.	Dyspepsia, irritability, drowsiness, and increased libido are possible.	During treatment, the functional parameters of the urinary system should be monitored.

	Method of administration and dosage	Side effects	Special instructions
Glycine	Take 1 tablet under the tongue up to 3 times a day for 2 or 4 weeks.	Rarely, allergies may develop.	Glycine does not accumulate in the body, is well tolerated, does not cause addiction. Glycine treatment can be carried out 4-6 times a year.

Prevention

There are no specific measures to prevent Alice in Wonderland syndrome, because the disease is considered rare and has not yet been studied very well. However, doctors can provide general recommendations for preventing such conditions.

1. Stress resistance, the ability to withstand stress - if you develop such qualities in yourself, then diseases such as Alice in Wonderland syndrome, and other neuroses and phobias, will pass you by.
2. Good rest, walks, active games and sports have an overall positive effect on health, both physical and mental.
3. Yoga and meditation are considered excellent ways to relax, strengthen the nervous system, and relieve stress. The only condition is that meditation and yoga should be practiced regularly.
4. A healthy lifestyle is an integral part of preventing Alice syndrome, because alcohol, drugs and psychotropic substances can easily provoke the development of the disease.
5. Proper nutrition should include the exclusion of foods that can trigger migraine attacks. These foods include coffee, strong tea, alcoholic beverages, chocolate, and cocoa.

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Forecast

Alice in Wonderland syndrome is still a poorly understood disease. And there is no specific treatment plan for this pathology yet. With the right approach and correctly selected medications, it is possible to reduce the duration and number of attacks. This allows the patient to expand communication, facilitate his social adaptation and even restore his ability to work.

High-quality psychotherapy can rid the patient of the phobias that have arisen, which will allow him to return to the normal lifestyle of a healthy person.

Despite the treatment, it is still considered almost impossible to completely eliminate Alice in Wonderland syndrome.

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