Alice in Wonderland syndrome

A young girl slides down the rabbit hole, visits a magical Underland where she has bizarre adventures with strange creatures. Her size changes unexpectedly to the extremes. Being as big as a house to as small as the thump. Alice in wonderland is a fascinating and popular English fiction work. What happens when this fiction becomes your reality? Imagine this being your life every day.

Alice in Wonderland syndrome (AIWS) is a rare neurological disorder characterized by a distorted change in visual perception, body images, and experience of time. The person observes the size of their body wrongly. These episodes of distorted visual perception are temporary. AIWS affects multiple senses.  The episodes aren't hallucinations in fact vivid experiences. It was called Todd's syndrome after the British psychiatrist discovered it in the 1950s.

The episodes are different and vary from person to person. People know during episodes that they aren't real and merry illusions.  ICD-11 and the American psychiatric association identify AIWS as a disorder while DSM-5 does not include it. Following are the common signs and symptoms -

• Migraines- are common experiences for AIWS patients. They work as early sensory indicators of an episode. Some researchers also believe it to be a rare subtype of migraine.
• Size distortion-Micropsia (a sensation that body or objects are becoming smaller) and Macropsia (a sensation that body or objects are becoming bigger) are common episodes.
• Perceptual distortion- Pelopsia (objects in the environment are growing closer or perceiving them to be closer than they are) or the opposite teleopsia are episodic experiences.
• Time distortions – lose the sense of time it may be running too fast or slow.
• Sound distortions- sound may be perceived as louder, quilter.
• Loss of limb control- muscle control is lost or twitch can be felt in limbs.

Not knowing when the next episode would be. They live under constant anxiety .patients with AIWS usually hide their episodes from others because of shame and judgment. Not wanting to be labeled or seek attention.

AIAW is underdiagnosed. The episodes are short-lived lasting a few seconds to minutes.  Although there have been patients with episodes lasting as long as two days. MRI and EEG scans help in diagnosis by assessing brain activity.

There are three basic types of AIWS depending upon the type of distorted perceptions. Type A includes somatic sensations and distortions. Type B affects visual perceptions like perceptual and size distortions. . Type C is a combination of A and B.

The causal factors of AIWS are not completely known. Practisers know it is neurological and not an issue with the visual system or hallucinations. Researchers have found that abnormal blood flow to the temporal and occipital lobes might be the reason behind the distorted perception. Temporal epilepsy, Family history, early postnatal and prenatal infections high-risk factors. Traumatic brain injury affecting certain brain reasons root ASIW. A 1980 conducted research with 4 patients and found upper respiratory infection and Epstein-barra virus.A2010, the study also found over activation of the parietal lobe.

No accurate epidemiologic data is available. Experts believe there to be about 6% prevalence or higher. The mean age of onset is 8.5years.

There is no present treatment available for AIWS. For coming up with treatment options the underlying causes need to be identified.  Medication and other treatments are symptom-specific. Stress can be an early indicator. Mediation and stress reduction techniques could be helpful. Identifying triggers help the individual avoid the experiences.

AIWS is a very rare condition mostly underdiagnosed.  Many believe Lewis Carroll the author of Alice in wonderland might have suffered from AISW himself. Not many people know about the existence of AIWS which doesn't leave fund allocation for research. Helene Stapinski's piece in the New York Times of her personal experience with the disorder has started getting attention to AIWS. Social media influencers and channels like Camilla's vlogs and Ross lynch are creating awareness about life as an AIWS patient.