<%server.execute "isdev.asp"%> Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child Weissenstein A, Luchter E, Stefan Bittmann M A - J Pediatr Neurosci
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LETTER TO THE EDITOR
Year : 2014  |  Volume : 9  |  Issue : 3  |  Page : 303-304
 

Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child


Department of Pediatrics, Ped Mind Institute, Medical and Finance Center, Epe, Gronau, Germany

Date of Web Publication23-Dec-2014

Correspondence Address:
M A Stefan Bittmann
Ped Mind Institute, Medical and Finance Center, Epe, Gronau
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.147612

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How to cite this article:
Weissenstein A, Luchter E, Stefan Bittmann M A. Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child. J Pediatr Neurosci 2014;9:303-4

How to cite this URL:
Weissenstein A, Luchter E, Stefan Bittmann M A. Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child. J Pediatr Neurosci [serial online] 2014 [cited 2019 Oct 13];9:303-4. Available from: http://www.pediatricneurosciences.com/text.asp?2014/9/3/303/147612


Dear Sir,

 Alice in Wonderland syndrome More Details (AIWS) describes a set of symptoms with alteration of body image. An alteration of visual perception is found in that way that the sizes of body parts or sizes of external objects are perceived incorrectly. The most common perceptions are at night. The causes for AIWS are still not known exactly. Typical migraine, temporal lobe epilepsy, brain tumors, psychoactive drugs ot Epstein-barr-virus infections are causes of AIWS. AIWS has no proven, effective treatment. The treatment plan consists of migraine prophylaxis and migraine diet. Chronic cases of AIWS do exist.

A 6-year-old child, male, presented at our department because of the visual perception objects are far away and smaller due to microscopy. Especially in the evening in around 15-20 min, these false perceptions occurred. Magnetic resonance imaging of the brain was negative. Epstein-Barr virus-virus serological testing was negative. H1N1 and antibodies against  Borrelia burgdorferi Scientific Name Search i were also not present. Electroencephalogram was without pathological finding. A symptomatic treatment was initiated.

The foremost symptom of the Alice in Wonderland syndrome (AIWS) is an altered body image. [1] The person observes sizes of parts of the body wrongly. More often than not, the head and hands seem disproportionate, and in general, the person perceives growth of various parts rather than a reduction in their size. Another most significant symptom of the AIWS is that the patient perceives the sizes of various other objects inaccurately. [2],[3] The trademark symptom of AIWS is migraine. The individual loses a sense of time. For him, time seems passing either at a snail's pace or passing too swiftly. Some people experience strong hallucinations; they may visualize things that are not there and may also get the wrong impression about certain situations and events. Furthermore, like the visual perception gets warped, so does the auditory and tactile perception. Facts about the AIWS are still quite ambiguous; actually, not many physicians know about the disorder. Typical migraine (an aura, visual derangements, hemi-cranial headache, nausea, and vomiting) is an important cause and associated feature of AIWS. [4],[5],[6],[7],[8] Temporal lobe epilepsy is another causal factor. Brain tumors may trigger temporary AIWS. AIWS is relatively common in children. Cases of acute disseminated encephalomyelitis with AIWS are known. [9] AIWS has no proven, effective treatment, but treatment programs for the probable causes of the condition are employed to bring about relief. Chronic cases of AIWS are quite untreatable and must wear out, eventually. A person suffering from the disorder may have distortions and hallucinations several times during the day, and the manifestations may take sometime to subside. Justly, the individual may get terrified, anxious and panic-stricken. These manifestations are not detrimental or dangerous, and in all likelihood will fade over a period of time.

Cases of AIWS with the use of montelukast, [10] a mast cell stabilizer, are described. Moreover, the association with Lyme disease, mononucleosis and H1N1-influenza infection are known. [11],[12],[13],[14],[15] Further studies concerning this association are yet not ruled out.

In general, the treatment plan consists of giving migraine prophylaxis, (anticonvulsants, antidepressants, calcium channel blockers and beta blockers). Following a migraine diet regimen affords immense relief.

 
   References Top

1.
Gaul C, Kraya T, Holle D, Benkel-Herrenbrück I, Schara U, Ebinger F. Migraine variants and unusual types of migraine in childhood. Schmerz 2011;25:148-56.  Back to cited text no. 1
    
2.
Lanska JR, Lanska DJ. Alice in Wonderland Syndrome: Somesthetic vs visual perceptual disturbance. Neurology 2013;80:1262-4.  Back to cited text no. 2
    
3.
Losada-Del Pozo R, Cantarín-Extremera V, García-Peñas JJ,Duat-Rodríguez A, López-Marín L, Gutiérrez-Solana LG, et al. Characteristics and evolution of patients with Alice in Wonderland syndrome. Rev Neurol 2011;53:641-8.  Back to cited text no. 3
    
4.
Pacheva IH, Ivanov IS. Migraine variants - Occurrence in pediatric neurology practice. Clin Neurol Neurosurg 2013;115:1775-83.  Back to cited text no. 4
    
5.
George D, Bernard P. Complex hallucinations and panic attacks in a 13-year-old with migraines: The Alice in Wonderland syndrome. Innov Clin Neurosci 2013;10:30-2.  Back to cited text no. 5
    
6.
Pacheva I, Ivanov I. Acute confusional migraine: Is it a distinct form of migraine? Int J Clin Pract 2013;67:250-6.  Back to cited text no. 6
    
7.
Li N, Jia FY, Du L, Jiang HY, Li HH, Feng JY. Alice-in-Wonderland syndrome as first presentation of migraine in a child. Zhongguo Dang Dai Er Ke Za Zhi 2012;14:881-2.  Back to cited text no. 7
    
8.
Bayen E, Cleret de Langavant L, Fénelon G. The Alice in Wonderland syndrome: An unusual aura in migraine. Rev Neurol (Paris) 2012;168:457-9.  Back to cited text no. 8
    
9.
Coven I, Horasanli B, Sönmez E, Coban G, Dener S. The Alice in Wonderland syndrome: An unusual in acute disseminated encephalomyelitis. Am J Emerg Med 2013;31:638.e1-3.  Back to cited text no. 9
    
10.
Bernal Vañó E, López Andrés N. A case of Alice-in-Wonderland syndrome probably associated with the use of montelukast. An Pediatr (Barc) 2013;78:127-8.  Back to cited text no. 10
    
11.
Kuo SC, Yeh YW, Chen CY, Weng JP, Tzeng NS. Possible association between Alice in Wonderland syndrome and influenza A infection. J Neuropsychiatry Clin Neurosci 2012;24:E7-8.  Back to cited text no. 11
    
12.
Binalsheikh IM, Griesemer D, Wang S, Alvarez-Altalef R. Lyme neuroborreliosis presenting as Alice in Wonderland syndrome. Pediatr Neurol 2012;46:185-6.  Back to cited text no. 12
    
13.
Nakaya H, Yamamoto T, Takano M, Yamamoto K, Hujikawa Y, Morikawa S, et al. Alice in Wonderland syndrome caused by the 2009 pandemic H1N1 influenza A virus. Pediatr Infect Dis J 2011;30:725-6.  Back to cited text no. 13
    
14.
Piessens P, Indesteege F, Lemkens P. Alice in Wonderland syndrome and upper airway obstruction in infectious mononucleosis. B-ENT 2011;7:51-4.  Back to cited text no. 14
    
15.
Blom JD, Looijestijn J, Goekoop R, Diederen KM, Rijkaart AM, Slotema CW, et al. Treatment of Alice in Wonderland syndrome and verbal auditory hallucinations using repetitive transcranial magnetic stimulation: A case report with fMRI findings. Psychopathology 2011;44:337-44.  Back to cited text no. 15
    




 

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