Alice in Wonderland Syndrome: Somesthetic vs. Visual Perceptual Disturbance (P01.117)

Abstract

Objective: To determine whether clinical characteristics of Alice in Wonderland syndrome (AIWS) depend on type of perceptual disorder involved.

Background In 1955, Todd defined AIWS as self-experienced paroxysmal body-image illusions involving distortions of size, mass, shape, or position. Todd named the AIWS for the perceptual disorder of altered body image experienced by the protagonist in Lewis Carroll's novel Alice's Adventures in Wonderland (1865). By the original definition, the obligatory core symptom of AIWS is a distortion of the body schema. However, since Todd's description, some authors have included cases with visual or mixed perceptual disturbances.

Design/Methods: We performed a systematic synthesis of English-language reports of AIWS identified by PubMed. Cases with visual and somesthetic perceptual disorders not identified as AIWS were excluded. Abstracted information included type of perceptual disorder, etiology, age, sex, duration, and evidence of focal brain lesions. Perceptual disorders were categorized as somesthetic (Type A), visual (Type B), or both (Type C).

Results: We identified 81 cases: Type A, 9 (11%); Type B, 59 (73%); Type C, 13 (16%). Epstein Barr virus (EBV) was the most commonly identified cause (n=39, 48%), followed by migraine (n=9, 11%). EBV was most frequent in Type B cases (Type A, 11%; Type B, 61%; Type C, 15%). Migraine was most frequent in Type C (Type A, 22%; Type B, 0%; Type C, 46%). Median age (years) varied by Type (Type A, 17; Type B, 8; Type C, 20) with Type B cases overall younger (predominantly EBV). Of cases with gender recorded (n=64), 47% were male without significant differences across Type.

Conclusions: In AIWS clinical characteristics depend on the type of perceptual disorder involved. Those with isolated visual perceptual disorders occur preferentially in young individuals with EBV, whereas mixed perceptual disorders occur preferentially in older migraineurs.

Supported by: Department of Veterans Affairs.

Disclosure: Mr. Lanska has received personal compensation for activities with Medlink. Dr. Lanska has received personal compensation in an editorial capacity for Medlink Neurology.