blom-2016-alice-in-wonderland-syndrome-2

Purpose of Review: To summarize the literature on Alice in Wonderland syndrome (AIWS) characterized by distortions of visual perception, body schema, and time experience.
Recent Findings: Based on 169 published case descriptions, AIWS etiology is divided into 8 main groups including neurologic disorders (mainly affecting adults and elderly patients) and encephalitides affecting younger patients. Nonclinical symptoms can be reported by up to 30% of adolescents. Auxiliary investigations such as blood tests, EEG, and brain MRI are recommended for clinical cases. Treatment focuses on the underlying condition, with reassurance being sufficient in approximately 50% of cases.
Summary: A call for inclusion of AIWS in international classifications such as DSM and ICD for research purposes.

First Described: AIWS was first identified in 1955 and is characterized by perceptual distortions similar to those experienced by Alice in Lewis Carroll’s "Alice’s Adventures in Wonderland.
Scientific Attention: Increasing interest in AIWS due to brain imaging techniques allowing exploration of brain networks mediating its symptoms.
Diagnostic and Therapeutic Consequences: Differentiation from schizophrenia and other psychiatric disorders.

Systematic Literature Search: Conducted via PubMed until June 2015 using specific search terms and including various languages. 130 initial hits, resulting in 70 articles focused on AIWS.
Patient Demographics: Analysis included 170 patients, with mean age 15.5 years; 55.6% male.

Clinical vs Nonclinical AIWS: Symptoms classified as "clinical" (associated with diagnosed conditions) and "nonclinical" (experienced by the general population).
Conditions Associated with AIWS: Detailed in Table 1, including infectious diseases, CNS lesions, PNS lesions, and psychiatric disorders.
- Common Conditions: Encephalitis is most reported in youths (21.7%) and migraine in adults (9.6%).

Historical Perspective: John Todd coined AIWS to encompass various symptoms traditionally associated with migraine and epilepsy.
Phenomenology: Over 42 visual symptoms and 16 somesthetic/non-visual symptoms have been classified.
- Distortions vs Hallucinations: Emphasis on AIWS symptoms being distortions rather than hallucinations or illusions.

Frequency of metamorphopsias, with micropsia (58.6%) and macropsia (45.0%) being the most common.
Duration: Symptoms usually last from minutes to days but can persist longer.

Patterns of distortion include derealization, depersonalization, and body schema illusions.

No comprehensive population data on AIWS; clinical studies suggest 15% prevalence in migraine sufferers.
Studies in adolescents show notable lifetime prevalence for symptoms associated with AIWS.

Symptoms linked to functional and structural anomalies within perceptual systems; predominantly central pathology.

Various conditions mediate AIWS symptoms; Substance-Induced Disorders include hallucinogen persisting perception disorder (HPPD).

AIWS is not currently included in ICD or DSM. Diagnosis involves thorough history, physical examination, and possibly additional imaging or tests.

Most cases are benign and often resolve with reassurance. Chronic conditions may necessitate tailored pharmacological treatments but rarely involve antipsychotics.

AIWS cases are underreported; a lack of systematic epidemiological data complicates understanding.
Further research needed to determine efficacy of different treatment approaches.

AIWS symptoms frequently occur in the general population and warrant further investigation. Auxiliary examinations are recommended for clinical cases, emphasizing the need for targeted treatment of underlying conditions. Advocacy for AIWS's inclusion in major diagnostic manuals is needed to legitimize the condition in clinical practice.