PT  - JOURNAL ARTICLE
AU  - Fine, Edward
AU  - Farooq, Osman
AU  - Finnegan, Sarah
AU  - Zambrano, Maria
AU  - Nasser, Mohamed
TI  - Alice in Wonderland Syndrome: Case Series and Analysis (P4.6-030)
DP  - 2019 Apr 09
TA  - Neurology
PG  - P4.6-030
VI  - 92
IP  - 15 Supplement
4099  - http://n.neurology.org/content/92/15_Supplement/P4.6-030.short
4100  - http://n.neurology.org/content/92/15_Supplement/P4.6-030.full
SO  - Neurology2019 Apr 09; 92
AB  - Objective: To describe a cohort of 20 cases of Alice in Wonderland Syndrome from an academic child neurology service.Background: Alice in Wonderland Syndrome (AIWS) is a disorienting neurological condition affecting perception of vision, hearing, touch, sensation and passage of time. Individuals with AIWS also experience alterations in perception of size of objects such as macropsia, teichopsia or micropsia, relations to their own or others body parts, in colors, and other metamorphopsias. AIWS may occur in migraine aura, complex partial epilepsy, and infectious or febrile statesDesign/Methods: Retrospective review of patients presenting with symptoms of AIWS and identifying various underlying etiologies. PubMed searched by terms: AIWS, pseudotumor cerebri, borreliosis, metamorphopsia, migraine headache, epilepsy , cerebral concussion.Results: Twenty patients, ages 5–21 years, were identified with AIWS: 11 female (56%) and 9 male (44%). Four patients had complex partial epilepsy; 3 had with prolonged aura with migraine and 1 with multiple contusions. 1 patient had AIWS with sleep deprivation and 1 during episodes of pseudotumor cerebri. Ten had symptoms during febrile or infectious states from several etiologies including infectious mononucleosis and borreliosis. Nine patients had EEG performed, 4 of which were abnormal. Sharp waves and/or discharges localized to frontal, temporal or occipital lobes.Conclusions: Etiologies of AIWS are multifactorial. We report the first cases of AIWS occurring after concussions and another linked to pseudotumor cerebri. AIWS patients 13 years and younger had infective or febrile etiologies. AIWS patients, ages 13–21, mostly had epilepsy or headache. Prompt recognition of AIWS phenomena led to appropriate and effective therapy. Reassurances and/or explanations without medication alleviated anxieties of patients and parents. Detailed summaries of unique cases will be provided at presentation. To our knowledge this is the largest cohort of patients reported from a single academic center.Disclosure: Dr. Fine has nothing to disclose. Dr. Farooq has nothing to disclose. Dr. Finnegan has nothing to disclose. Dr. Zambrano has nothing to disclose. Dr. Nasser has nothing to disclose.