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Fitzek MP, Mecklenburg J, Overeem LH, Lange KS, Siebert A, Triller P, Neeb L, Dreier JP, Kondziella D, Reuter U, Raffaelli B. Alice in Wonderland Syndrome (AIWS): prevalence and characteristics in adults with migraine. J Neurol 2024; 271:5146-5155. [PMID: 38822148 PMCID: PMC11319383 DOI: 10.1007/s00415-024-12471-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE Alice in Wonderland Syndrome (AIWS) is a sensory disorder characterized by a distorted somatosensory and/or visual perception. Additionally, distortion of time perception and symptoms of derealization/depersonalization may occur. AIWS is frequently associated with migraine. However, its prevalence, and clinical characteristics remain poorly understood. Here, we investigated the prevalence and features of AIWS in individuals with migraine. We hypothesized AIWS is more frequent in migraine patients with aura than in those without aura. METHODS This was a prospective cross-sectional cohort study, conducted at a tertiary headache center. Participants with migraine filled out questionnaires, providing details on demographics, headache, AIWS characteristics and the occurrence of transient visual phenomena such as fragmented vision. RESULTS Of 808 migraine patients, 133 individuals (16.5%, mean age 44.4 ± 13.3 years, 87% women) reported AIWS symptoms throughout their lives. Micro- and/or telopsia (72.9%) were most frequent, followed by micro- and/or macrosomatognosia (49.6%), and macro- and/or pelopsia (38.3%), lasting on average half an hour. AIWS symptoms occurred in association with headache in 65.1% of individuals, and 53.7% had their first AIWS episode at the age of 18 years or earlier. Migraine patients with aura were more likely to report AIWS symptoms than those without aura (19.5% vs. 14.1%, p = 0.04). Participants with AIWS reported a higher incidence of 17 out of the 22 investigated visual phenomena. CONCLUSION AIWS symptoms appear to be a common lifetime phenomenon in migraine patients. The correlation and clinical parallels between AIWS and migraine aura could indicate shared underlying pathomechanisms.
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Affiliation(s)
- Mira P Fitzek
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Junior Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Jasper Mecklenburg
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Lucas H Overeem
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Kristin S Lange
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Anke Siebert
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Paul Triller
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Lars Neeb
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Helios Global Health, Berlin, Germany
| | - Jens P Dreier
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Center for Stroke Research, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, GermanyUniversitätsmedizin Berlin, Berlin, Germany
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Berlin, Germany
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uwe Reuter
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | - Bianca Raffaelli
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany.
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Kobayashi Y, Tazawa KI, Mochizuki Y, Kondo Y, Yamamoto K, Sekijima Y. Two Cases of Alice in Wonderland Syndrome with a Right Occipital Lobe Lesion Caused by Isolated Cortical Venous Thrombosis. Intern Med 2024; 63:2083-2087. [PMID: 38044156 PMCID: PMC11309861 DOI: 10.2169/internalmedicine.2092-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023] Open
Abstract
Alice in Wonderland syndrome (AIWS) is extremely rare, occurring more often in young individuals than in older adults. Symptoms of this syndrome typically include an altered body image, size perception, and time perception. However, the pathophysiology and lesions responsible for this syndrome remain unclear. In most cases, specific lesions cannot be identified using computed tomography or magnetic resonance imaging. Two patients with isolated cortical venous thrombosis in the right occipital area experienced transient visual symptoms of AIWS. Furthermore, a literature search indicated that AIWS with visual distortions is associated with right occipital lobe lesions, supporting the findings of our study.
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Affiliation(s)
- Yuya Kobayashi
- Department of Neurology, Nagano Municipal Hospital, Japan
- Department of Neurology, Ina Central Hospital, Japan
| | - Ko-Ichi Tazawa
- Department of Neurology, Nagano Red Cross Hospital, Japan
| | | | - Yasufumi Kondo
- Department of Neurology, Nagano Municipal Hospital, Japan
| | - Kanji Yamamoto
- Department of Neurology, Nagano Municipal Hospital, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
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Friedrich MU, Baughan EC, Kletenik I, Younger E, Zhao CW, Howard C, Ferguson MA, Schaper FLWVJ, Chen A, Zeller D, Piervincenzi C, Tommasin S, Pantano P, Blanke O, Prasad S, Nielsen JA, Fox MD. Lesions Causing Alice in Wonderland Syndrome Map to a Common Brain Network Linking Body and Size Perception. Ann Neurol 2024. [PMID: 38949221 DOI: 10.1002/ana.27015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Alice in Wonderland syndrome (AIWS) profoundly affects human perception of size and scale, particularly regarding one's own body and the environment. Its neuroanatomical basis has remained elusive, partly because brain lesions causing AIWS can occur in different brain regions. Here, we aimed to determine if brain lesions causing AIWS map to a distributed brain network. METHODS A retrospective case-control study analyzing 37 cases of lesion-induced AIWS identified through systematic literature review was conducted. Using resting-state functional connectome data from 1,000 healthy individuals, the whole-brain connections of each lesion were estimated and contrasted with those from a control dataset comprising 1,073 lesions associated with 25 other neuropsychiatric syndromes. Additionally, connectivity findings from lesion-induced AIWS cases were compared with functional neuroimaging results from 5 non-lesional AIWS cases. RESULTS AIWS-associated lesions were located in various brain regions with minimal overlap (≤33%). However, the majority of lesions (≥85%) demonstrated shared connectivity to the right extrastriate body area, known to be selectively activated by viewing body part images, and the inferior parietal cortex, involved in size and scale judgements. This pattern was uniquely characteristic of AIWS when compared with other neuropsychiatric disorders (family-wise error-corrected p < 0.05) and consistent with functional neuroimaging observations in AIWS due to nonlesional causes (median correlation r = 0.56, interquartile range 0.24). INTERPRETATION AIWS-related perceptual distortions map to one common brain network, encompassing regions critical for body representation and size-scale processing. These findings lend insight into the neuroanatomical localization of higher-order perceptual functions, and may inform future therapeutic strategies for perceptual disorders. ANN NEUROL 2024.
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Affiliation(s)
- Maximilian U Friedrich
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Isaiah Kletenik
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ellen Younger
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Charlie W Zhao
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA
| | - Calvin Howard
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA
| | - Michael A Ferguson
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA
| | - Frederic L W V J Schaper
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Amalie Chen
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Daniel Zeller
- Department of Neurology, University Hospital Wuerzburg, Würzburg, Germany
| | | | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sashank Prasad
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA
| | - Jared A Nielsen
- Department of Psychology, Brigham Young University, Provo, UT
- Neuroscience Center, Brigham Young University, Provo, UT
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Tralongo P, Bakacs A, Larocca LM. EBV-Related Lymphoproliferative Diseases: A Review in Light of New Classifications. Mediterr J Hematol Infect Dis 2024; 16:e2024042. [PMID: 38882456 PMCID: PMC11178045 DOI: 10.4084/mjhid.2024.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/16/2024] [Indexed: 06/18/2024] Open
Abstract
Epstein-Barr virus (EBV) is a prevalent virus that can be detected in the vast majority of the population. Most people are asymptomatic and remain chronically infected throughout their lifetimes. However, in some populations, EBV has been linked to a variety of B-cell lymphoproliferative disorders (LPDs), such as Burkitt lymphoma, classic Hodgkin lymphoma, and other LPDs. T-cell LPDs have been linked to EBV in part of peripheral T-cell lymphomas, angioimmunoblastic T-cell lymphomas, extranodal nasal natural killer/T-cell lymphomas, and other uncommon histotypes. This article summarizes the current evidence for EBV-associated LPDs in light of the upcoming World Health Organization classification and the 2022 ICC classification.
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Affiliation(s)
- Pietro Tralongo
- Division of Anatomic Pathology and Histology - Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Arianna Bakacs
- Division of Anatomic Pathology and Histology - Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology - Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
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Manwar S, Sapkale B, Patil T, Vagga A. A Twist in Perception: A Case of an Eight-Year-Old Female With Alice in Wonderland Syndrome. Cureus 2024; 16:e60182. [PMID: 38868275 PMCID: PMC11167684 DOI: 10.7759/cureus.60182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
The article aims to explore the challenges involved in diagnosing and managing Alice in Wonderland Syndrome (AIWS) in pediatric cases, focusing on an eight-year-old female with perceptual distortions affecting vision, hearing, and time perception. AIWS, a rare neurological phenomenon, manifests as distortions in the perception of the body and external stimuli. The lack of established diagnostic criteria, particularly in the pediatric population, complicates accurate identification. The presented case illustrates visual anomalies, auditory abnormalities, and tachysensia, emphasizing the multisensory nature of AIWS. The temporal association with underlying causes, such as migraines and viral infections, highlights the need for a comprehensive evaluation. The Acharya Vinoba Bhave Rural Hospital management approach involves a systematic assessment, identification of underlying chronic conditions, and targeted treatment. Migraine prophylaxis, utilizing prescription drugs and a low-tyramine diet, plays a central role. The limited use of antipsychotics underscores the neurological origin of AIWS. The article contributes valuable insights into pediatric AIWS, advocating for further research and awareness. The article also aims to highlight the lack of established diagnostic criteria for AIWS, particularly in the pediatric population, and to present a systematic management approach based on a specific case study. The multidisciplinary collaboration, regular follow-ups, and patient education constitute a comprehensive approach to enhance understanding and alleviate symptoms in AIWS cases.
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Affiliation(s)
- Suchita Manwar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhagyesh Sapkale
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Truptesh Patil
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anjali Vagga
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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6
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Ma Y, Zhao Y, Ma Y. Kernel Bayesian nonlinear matrix factorization based on variational inference for human-virus protein-protein interaction prediction. Sci Rep 2024; 14:5693. [PMID: 38454139 PMCID: PMC10920681 DOI: 10.1038/s41598-024-56208-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
Identification of potential human-virus protein-protein interactions (PPIs) contributes to the understanding of the mechanisms of viral infection and to the development of antiviral drugs. Existing computational models often have more hyperparameters that need to be adjusted manually, which limits their computational efficiency and generalization ability. Based on this, this study proposes a kernel Bayesian logistic matrix decomposition model with automatic rank determination, VKBNMF, for the prediction of human-virus PPIs. VKBNMF introduces auxiliary information into the logistic matrix decomposition and sets the prior probabilities of the latent variables to build a Bayesian framework for automatic parameter search. In addition, we construct the variational inference framework of VKBNMF to ensure the solution efficiency. The experimental results show that for the scenarios of paired PPIs, VKBNMF achieves an average AUPR of 0.9101, 0.9316, 0.8727, and 0.9517 on the four benchmark datasets, respectively, and for the scenarios of new human (viral) proteins, VKBNMF still achieves a higher hit rate. The case study also further demonstrated that VKBNMF can be used as an effective tool for the prediction of human-virus PPIs.
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Affiliation(s)
- Yingjun Ma
- School of Mathematics and Statistics, Xiamen University of Technology, Xiamen, China
| | - Yongbiao Zhao
- School of Computer, Central China Normal University, Wuhan, China
| | - Yuanyuan Ma
- School of Computer Engineering, Hubei University of Arts and Science, Xiangyang, China.
- Hubei Key Laboratory of Power System Design and Test for Electrical Vehicle, Hubei University of Arts and Science, Xiangyang, China.
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7
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Hosokawa K, Oi K, Hitomi T, Mitsueda T, Nakagawa T, Ikeda A. [A case of Alice in Wonderland syndrome after Epstein-Barr virus (EBV) encephalitis: a mimicry of focal epileptic seizure]. Rinsho Shinkeigaku 2024; 64:99-104. [PMID: 38281750 DOI: 10.5692/clinicalneurol.cn-001906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
A 30-year-old man who received infliximab for treatment of Crohn's disease developed Epstein-Barr virus (EBV) encephalitis, which responded well to therapy; however, he had left lower visual field loss following treatment. The patient noticed peculiar symptoms 9 months after recovery from encephalitis; objects in his view appeared smaller or larger than their actual size (micropsia/macropsia). Moreover, it appeared that objects outside moved faster or slower than their actual speed of movements and moving objects appeared as a series of many consecutive snap shots. His vision was blurred, and he had visual difficulties and a sensation that his body was floating. These symptoms mainly appeared following fatigue and persisted over approximately 10 years. Based on cerebrospinal fluid analysis, brain MRI, N-isopropyl-p-123I-iodoamphetamine with single photon emission computed tomography, fluorodeoxyglucose positron emission tomography, and electroencephalography, we excluded both recurrent encephalitis and focal epileptic seizures. By taking all symptoms and other evaluation findings into account, the patient most likely suffered from "Alice in Wonderland syndrome" which is primarily associated with cortical dysfunction in the right temporo-parieto-occipital area as the consequence of previous acute EBV encephalitis.
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Affiliation(s)
- Kyoko Hosokawa
- Department of Neurology, Kyoto University Graduate School of Medicine
- Present address: Department of Neurology, National Hospital Organization Minami Kyoto Hospital
| | - Kazuki Oi
- Department of Neurology, Kyoto University Graduate School of Medicine
- Present address: Department of Neurology, National Hospital Organization Nara Medical Center
| | - Takefumi Hitomi
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine
| | | | - Tomokazu Nakagawa
- Department of Neurology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital
- Present address: Department of Neurology, Takatsuki Red Cross Hospital
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
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Mastria G, Mancini V, Viganò A, Piervincenzi C, Petsas N, Puma M, Giannì C, Pantano P, Di Piero V. Neuroimaging markers of Alice in Wonderland syndrome in patients with migraine with aura. Front Neurol 2023; 14:1210811. [PMID: 37767534 PMCID: PMC10520557 DOI: 10.3389/fneur.2023.1210811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023] Open
Abstract
Background The Alice in Wonderland syndrome (AIWS) is a transient neurological disturbance characterized by sensory distortions most frequently associated with migraine in adults. Some lines of evidence suggest that AIWS and migraine might share common pathophysiological mechanisms, therefore we set out to investigate the common and distinct neurophysiological alterations associated with these conditions in migraineurs. Methods We conducted a case-control study acquiring resting-state fMRI data from 12 migraine patients with AIWS, 12 patients with migraine with typical aura (MA) and 24 age-matched healthy controls (HC). We then compared the interictal thalamic seed-to-voxel and ROI-to-ROI cortico-cortical resting-state functional connectivity between the 3 groups. Results We found a common pattern of altered thalamic connectivity in MA and AIWS, compared to HC, with more profound and diffuse alterations observed in AIWS. The ROI-to-ROI functional connectivity analysis highlighted an increased connectivity between a lateral occipital region corresponding to area V3 and the posterior part of the superior temporal sulcus (STS) in AIWS, compared to both MA and HC. Conclusion The posterior STS is a multisensory integration area, while area V3 is considered the starting point of the cortical spreading depression (CSD), the neural correlate of migraine aura. This interictal hyperconnectivity might increase the probability of the CSD to directly diffuse to the posterior STS or deactivating it, causing the AIWS symptoms during the ictal phase. Taken together, these results suggest that AIWS in migraineurs might be a form of complex migraine aura, characterized by the involvement of associative and multisensory integration areas.
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Affiliation(s)
- Giulio Mastria
- My Space Lab, Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Valentina Mancini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | | | | | | | - Marta Puma
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Costanza Giannì
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Saito G, Takagi G. Multisensory perceptual distortion including auditory distortions in Alice in Wonderland syndrome: a case report. Neurocase 2023; 29:46-49. [PMID: 38678303 DOI: 10.1080/13554794.2024.2345402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
Alice in Wonderland syndrome (AIWS) is a rare perceptual disorder characterized mainly by perceptual distortions of visual objects and one's own body. While there are many case reports of visual and somatosensory distortions associated with AIWS, little is known about auditory distortion. Therefore, we present the case of a 22-year-old right-handed woman who described having auditory as well as visual and somatosensory distortion experiences and a family history of AIWS. The subject reported experiencing multisensory perceptual distortions, where she sees other people's faces as larger and hears their voices as louder at the same time. This particular case suggests that auditory distortion - which contributes to constructing the perception of the surrounding space and the body - may also be characterized as a perceptual symptom of AIWS.
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Affiliation(s)
- Godai Saito
- Research Institute of Electrical Communication, Tohoku University, Sendai, Japan
- Department of Psychology, Graduate School of Arts and Letters, Tohoku University, Sendai, Japan
| | - Gen Takagi
- Faculty of Comprehensive Welfare, Tohoku Fukushi University, Sendai, Japan
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Costagliola G, Vallario MP, Santangelo A, Foiadelli T, Ragone MC, Battini R, Tinelli F, Di Cicco ME, Bonuccelli A, Gaeta G, Iozzi C, Peroni DG, Operto FF, Consolini R, Orsini A. Neurovisual Manifestations in Children with Mild COVID-19: An Association to Remember. Neuroophthalmology 2023; 47:75-78. [PMID: 36891409 PMCID: PMC9988337 DOI: 10.1080/01658107.2023.2174560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 02/18/2023] Open
Abstract
Neurovisual involvement has been reported in a number of patients with severe SARS-CoV-2 disease (COVID-19), mainly among adult patients. In children, such involvement has been reported in rare cases, often in those presenting with severe forms of COVID-19. The aim of this work is to explore the association between mild COVID-19 and neurovisual manifestations. We report the cases of three previously healthy children who developed neurovisual manifestations following mild acute COVID-19, analysing the clinical phenotype, the latency between the onset of acute COVID-19 and neurovisual involvement, and the kinetic of resolution. Our patients developed different clinical patterns, including visual impairment and ophthalmoplegia. In two cases, these clinical features occurred during acute COVID-19, while in the third patient their development was delayed after 10 days from disease onset. Furthermore, the dynamics of resolution were different, with one patient showing remission after 24 hours, the second after 30 days, and the third showing persistence of the strabismus after 2 months of follow-up. The spreading of COVID-19 among the paediatric population will probably lead to an increase of atypical disease forms, including those presenting with neurovisual involvement. Therefore, a better knowledge of the pathogenic and clinical features of these manifestations is warranted.
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Affiliation(s)
- Giorgio Costagliola
- Pediatric Immunology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Michele Pio Vallario
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Santangelo
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Maria Cristina Ragone
- Ophthalmology Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Roberta Battini
- Department of Neuroscience, IRCSS Fondazione StellaMaris, Calambrone, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Tinelli
- Department of Neuroscience, IRCSS Fondazione StellaMaris, Calambrone, Italy
| | - Maria Elisa Di Cicco
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alice Bonuccelli
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Giovanni Gaeta
- Department of Pediatrics, Pediatric Department, Cecina Hospital, Cecina, Italy
| | - Chiara Iozzi
- Department of Pediatrics, Pediatric Department, Cecina Hospital, Cecina, Italy
| | - Diego Giampiero Peroni
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Rita Consolini
- Pediatric Immunology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
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Teelucksingh S, Murali Govind R, Dobson R, Nelson-Piercy C, Ovadia C. Treating Vestibular Migraine When Pregnant and Postpartum: Progress, Challenges and Innovations. Int J Womens Health 2023; 15:321-338. [PMID: 36814528 PMCID: PMC9940493 DOI: 10.2147/ijwh.s371491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
Vestibular migraine is a leading cause of vertigo in pregnancy and, although not a distinct migraine subtype, is an episodic syndrome associated with migraine. Vestibular migraine is associated with diverse symptoms such as vertigo, aura, allodynia, osmophobia, nausea, vomiting and tinnitus, many of which may be exacerbated by, masked or even dismissed in pregnancy. Vestibular migraine is likely an underdiagnosed and undertreated condition in pregnancy. The aetiology of vestibular migraine remains incompletely understood, although various theories have been proposed, including genetic predisposition, neurochemical dysregulation and pro-inflammatory mechanisms, all of which are derived from the pathophysiology of classical migraine. Physiologic changes to the endocrine, haematologic and vascular systems in pregnancy may affect pathophysiological processes in vestibular migraine, and can alter the course of symptoms experienced in pregnancy. These changes also predispose to secondary headache disorders, which may have similar presentations. There has been considerable progress in therapeutic advances in vestibular migraine prophylaxis and treatment outside of pregnancy. There is currently no significant evidence base for acute treatment or prophylaxis for pregnant patients, with treatment recommendations extrapolated from studies on classical migraine, and offered on a benefit versus risk basis. Challenges commonly encountered include difficulty establishing a diagnosis, in addition to recognising and treating neuropsychiatric and gestational co-morbidities. Anxiety, depression, hypertensive disorders and cardiovascular disease are closely associated with migraine, and important contributors to morbidity and mortality during pregnancy. Identifying and treating vestibular migraine during pregnancy offers a unique opportunity to impact future patient health through screening and early treatment of associated co-morbidities. There have been innovations in classical migraine therapy that may confer benefit in vestibular migraine in pregnancy, with emphasis on lifestyle modification, effective prophylaxis, abortive therapies, cognitive behaviour therapy and management of vestibular migraine-related comorbidities.
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Affiliation(s)
- Siara Teelucksingh
- Department of Obstetric Medicine, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Renuka Murali Govind
- Department of Obstetric Medicine, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Queen Mary University of London, London, UK
- Department of Neurology, Royal London Hospital, London, UK
| | - Catherine Nelson-Piercy
- Department of Obstetric Medicine, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
- Department of Women and Children’s Health, King’s College London, London, UK
| | - Caroline Ovadia
- Department of Women and Children’s Health, King’s College London, London, UK
- Department of Obstetrics and Gynaecology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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12
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The Perplexing Mental Health Comorbidity of Alice in Wonderland Syndrome (AIWS): A Case Study. PSYCHIATRY INTERNATIONAL 2023. [DOI: 10.3390/psychiatryint4010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The Alice in Wonderland Syndrome (AIWS) is an unusual and uncommon condition that falls under the umbrella of neurology and psychiatry. It is characterized by the presence of complex perceptual and visual discord. Additionally, there are visual hallucinations that are multi-dimensional. This syndrome was first described by John Todd in the 1950s, and it was loosely based on the book Alice in Wonderland. A man in his 30s arrived at his doctor’s appointment with a chief complaint of a pounding cluster headache that lasted over a full day. In addition, he mentioned that there was an aura preceding his headaches. The pain was so intense, it was debilitating him from routine activities. Before the headaches, he explained that he would sense bizarre physical and visual behaviors. During these episodes, he explained that things around him appeared distorted and of various sizes. Things in his room appeared to be more distant than they really were and larger in size (macropsia and micropsia). He described the fingers on his right hand to be much smaller compared to his left hand (micropsia). Objects around him were deformed and distorted (metamorphopsia). His symptoms lasted 45 minutes. He did not suffer from any previous headaches or hallucinations. He was a healthy man with a clean bill of health as per his medical records. Upon examination, the attending physician described the patient as alert, oriented to time and place, and under no obvious distress. All labs performed returned normal including a 10-panel drug test. These were tested to see if he was under the influence of any narcotic, stimulant, or other substances. The physician prescribed 500 mg of valproic acid to take daily. Three months later during his follow-up, he mentioned his symptoms had subsided but were still present. His dose was again increased to 1000 mg/day, eventually stopping all further symptoms from surfacing. He has not had another episode in three months. The Alice in Wonderland Syndrome is known to be associated with headaches with preceding auras. It is common in the pediatric and adult populations. In this paper, I introduce a case of a patient who displays migraines with preceding auras, indicative of AIWS.
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13
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Tu H, Pilato E, Sienaert P. Alice in Wonderland syndrome and bipolar depression. Bipolar Disord 2023; 25:251-253. [PMID: 36594746 DOI: 10.1111/bdi.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Hanna Tu
- University Psychiatric Center KU Leuven, Catholic University of Louvain (KU Leuven), Leuven, Belgium
| | - Eva Pilato
- Department of Neurosciences, University Psychiatric Center KU Leuven, Leuven, Belgium.,Research Group Psychiatry, Faculty of Medicine, Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, Leuven, Belgium
| | - Pascal Sienaert
- Department of Neurosciences, University Psychiatric Center KU Leuven, Leuven, Belgium.,Research Group Psychiatry, Faculty of Medicine, Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, Leuven, Belgium
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14
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Chapin TJ. Stabilization of the cervical spine through flexor endurance training for Alice in Wonderland syndrome presenting as an aura of migraine- A case report. J Bodyw Mov Ther 2023; 33:146-149. [PMID: 36775511 DOI: 10.1016/j.jbmt.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 05/18/2022] [Accepted: 09/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alice in Wonderland Syndrome is classified as a perceptual disorder. The sufferers report episodes of distorted visual perceptions, altered body schema, and distorted experiences of time. The syndrome can be caused by migraine headaches. Migraine headaches can be caused by cervical spine instability and aberrant intersegmental motion. METHODS Training the deep neck flexor endurance lead to a reduction in migraine headaches and in turn a reduction or secession of the Alice in Wonderland Syndrome episodes. RESULTS There is a resolution of the Alice in Wonderland Syndrome episodes after cervical spine stabilization is achieved. CONCLUSIONS Training of the deep neck flexors shows promise as a primary treatment of migraine headaches and should be further investigated.
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15
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Abstract
There is increasingly compelling evidence that microorganisms may play an etiological role in the emergence of mental illness in a subset of the population. Historically, most work has focused on the neurotrophic herpesviruses, herpes simplex virus type 1 (HSV-1), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) as well as the protozoan, Toxoplasma gondii. In this chapter, we provide an umbrella review of this literature and additionally highlight prospective studies that allow more mechanistic conclusions to be drawn. Next, we focus on clinical trials of anti-microbial medications for the treatment of psychiatric disorders. We critically evaluate six trials that tested the impact of anti-herpes medications on inflammatory outcomes in the context of a medical disorder, nine clinical trials utilizing anti-herpetic medications for the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or schizophrenia, and four clinical trials utilizing anti-parasitic medications for the treatment of schizophrenia. We then turn our attention to evidence for a gut dysbiosis and altered microbiome in psychiatric disorders, and the potential therapeutic effects of probiotics, including an analysis of more than 10 randomized controlled trials of probiotics in the context of schizophrenia, bipolar disorder (BD), and major depressive disorder (MDD).
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16
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Piervincenzi C, Petsas N, Viganò A, Mancini V, Mastria G, Puma M, Giannì C, Di Piero V, Pantano P. Functional connectivity alterations in migraineurs with Alice in Wonderland syndrome. Neurol Sci 2023; 44:305-317. [PMID: 36114397 DOI: 10.1007/s10072-022-06404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE Alice in Wonderland syndrome (AIWS) is a neurological disorder characterized by erroneous perception of the body schema or surrounding space. Migraine is the primary cause of AIWS in adults. The pathophysiology of AIWS is largely unknown, especially regarding functional abnormalities. In this study, we compared resting-state functional connectivity (FC) of migraine patients experiencing AIWS, migraine patients with typical aura (MA) and healthy controls (HCs). METHODS Twelve AIWS, 12 MA, and 24 HCs were enrolled and underwent 3 T MRI scanning. Independent component analysis was used to identify RSNs thought to be relevant for AIWS: visual, salience, basal ganglia, default mode, and executive control networks. Dual regression technique was used to detect between-group differences in RSNs. Finally, AIWS-specific FC alterations were correlated with clinical measures. RESULTS With respect to HCs, AIWS and MA patients both showed significantly lower (p < 0.05, FDR corrected) FC in lateral and medial visual networks and higher FC in salience and default mode networks. AIWS patients alone showed higher FC in basal ganglia and executive control networks than HCs. When directly compared, AIWS patients showed lower FC in visual networks and higher FC in all other investigated RSNs than MA patients. Lastly, AIWS-specific FC alterations in the executive control network positively correlated with migraine frequency. CONCLUSIONS AIWS and MA patients showed similar FC alterations in several RSNs, although to a different extent, suggesting common pathophysiological underpinnings. However, AIWS patients showed additional FC alterations, likely due to the complexity of AIWS symptoms involving high-order associative cortical areas.
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Affiliation(s)
| | | | | | - Valentina Mancini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Giulio Mastria
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,My Space Lab, Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Marta Puma
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Costanza Giannì
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS NEUROMED, Pozzilli, IS, Italy
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17
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The impact of visual dysfunctions in recent-onset psychosis and clinical high-risk state for psychosis. Neuropsychopharmacology 2022; 47:2051-2060. [PMID: 35982238 PMCID: PMC9556592 DOI: 10.1038/s41386-022-01385-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 11/09/2022]
Abstract
Subtle subjective visual dysfunctions (VisDys) are reported by about 50% of patients with schizophrenia and are suggested to predict psychosis states. Deeper insight into VisDys, particularly in early psychosis states, could foster the understanding of basic disease mechanisms mediating susceptibility to psychosis, and thereby inform preventive interventions. We systematically investigated the relationship between VisDys and core clinical measures across three early phase psychiatric conditions. Second, we used a novel multivariate pattern analysis approach to predict VisDys by resting-state functional connectivity within relevant brain systems. VisDys assessed with the Schizophrenia Proneness Instrument (SPI-A), clinical measures, and resting-state fMRI data were examined in recent-onset psychosis (ROP, n = 147), clinical high-risk states of psychosis (CHR, n = 143), recent-onset depression (ROD, n = 151), and healthy controls (HC, n = 280). Our multivariate pattern analysis approach used pairwise functional connectivity within occipital (ON) and frontoparietal (FPN) networks implicated in visual information processing to predict VisDys. VisDys were reported more often in ROP (50.34%), and CHR (55.94%) than in ROD (16.56%), and HC (4.28%). Higher severity of VisDys was associated with less functional remission in both CHR and ROP, and, in CHR specifically, lower quality of life (Qol), higher depressiveness, and more severe impairment of visuospatial constructability. ON functional connectivity predicted presence of VisDys in ROP (balanced accuracy 60.17%, p = 0.0001) and CHR (67.38%, p = 0.029), while in the combined ROP + CHR sample VisDys were predicted by FPN (61.11%, p = 0.006). These large-sample study findings suggest that VisDys are clinically highly relevant not only in ROP but especially in CHR, being closely related to aspects of functional outcome, depressiveness, and Qol. Findings from multivariate pattern analysis support a model of functional integrity within ON and FPN driving the VisDys phenomenon and being implicated in core disease mechanisms of early psychosis states.
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18
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Tanrıverdi Ç, Kara İ. A CASE OF MIGRAINE WITH SYMPTOMS OF PERCEPTION DISORDERS INCLUDING A FAMILY HISTORY. Neurocase 2022; 28:181-184. [PMID: 35465840 DOI: 10.1080/13554794.2022.2051560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Alice in Wonderland Syndrome is characterized by distortions in perception, especially with signs of micropsia or macropsia, peropia, teleopsia.The etiology of this syndrome includes migraine attacks, epilepsy, infections or substance abuse.In this case study, a 15-year-old adolescent girl was admitted to our child and adolescent psychiatry clinic with complaints of seeing objects and people as larger or smaller than they are and/or perceiving objects closer or farther than they are, before her migraine attacks.It was also stated that his father had similar complaints during his adolescence..In this case report, we present a case of migraine with aura.
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Affiliation(s)
- Çiğdem Tanrıverdi
- Child and Adolescent Psychiatry and Mental Health- Erzurum Bolge Egitim Ve Arastirma Hastanesi Erzurum, Turkey
| | - İhsan Kara
- Child and Adolescent Psychiatry and Mental Health- Erzurum Bolge Egitim Ve Arastirma Hastanesi Erzurum, Turkey
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19
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Panpruang P, Wongwandee M, Rattanajaruskul N, Roongsangmanoon W, Wongsoasu A, Angkananard T. Alice in Wonderland Syndrome-Like Seizure and Refractory Supraventricular Tachycardia. Case Rep Neurol 2021; 13:716-723. [PMID: 34950010 PMCID: PMC8647104 DOI: 10.1159/000519509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/21/2021] [Indexed: 11/30/2022] Open
Abstract
Alice in Wonderland syndrome (AIWS) is a rarely curious visual perceptual disorder which has been associated with diverse neurologic and psychiatric problems. It may be a manifestation in migraine, epileptic seizures, encephalitis, other brain lesions, medication-related side effects, schizophrenia, and depressive disorders. Principal character of AIWS is the disproportion between the external world and the self-image in which micropsia (objects appear smaller), macropsia (objects appear larger), and teleopsia (objects appear further away) are frequently reported. The cases of temporal lobe epilepsy may present with complex visual auras of visual distortions (e.g., micropsia and macropsia) like AIWS. We report an unusual case of an elderly man who presented with AIWS, focal impaired awareness seizures, ictal tachyarrhythmia, multiple episodes of transient visual disturbances of macropsia and transient loss of consciousness. During those symptoms, telemetry showed self-limited supraventricular tachycardia several times which could not be regulated with heart rate-controlled medication. The electroencephalography was later tested and showed rhythmic theta activity over the right cerebral hemisphere. He was treated with levetiracetam, and all his symptoms and tachyarrhythmias were gradually resolved thereafter. Refractory response to treatment would remind the physicians to reassess for the correct diagnosis.
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Affiliation(s)
- Pitirat Panpruang
- Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Monton Wongwandee
- Division of Neurology, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Nattapun Rattanajaruskul
- Division of Cardiovascular Medicine, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Worawut Roongsangmanoon
- Division of Cardiovascular Medicine, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Arthit Wongsoasu
- Division of Cardiovascular Medicine, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Teeranan Angkananard
- Division of Cardiovascular Medicine, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
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20
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Piervincenzi C, Petsas N, Giannì C, Di Piero V, Pantano P. Alice in Wonderland syndrome: a lesion mapping study. Neurol Sci 2021; 43:3321-3332. [PMID: 34859331 DOI: 10.1007/s10072-021-05792-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Alice in Wonderland syndrome (AIWS) is a rare neurological disorder, characterized by an erroneous perception of the body schema or surrounding space. It may be caused by a variety of neurological disorders, but to date, there is no agreement on which brain areas are affected. The aim of this study was to identify brain areas involved in AIWS. METHODS We conducted a literature search for AIWS cases following brain lesions. Patients were classified according to their symptoms as type A (somesthetic), type B (visual), or type C (somesthetic and visual). Using a lesion mapping approach, lesions were mapped onto a standard brain template and sites of overlap were identified. RESULTS Of 30 lesions, maximum spatial overlap was present in six cases. Local maxima were identified in the right occipital lobe, specifically in the extrastriate visual cortices and white matter tracts, including the ventral occipital fasciculus, optic tract, and inferior fronto-occipital fasciculus. Overlap was primarily due to type B patients (the most prevalent type, n = 22), who shared an occipital site of brain damage. Type A (n = 5) and C patients (n = 3) were rarer, with lesions disparately located in the right hemisphere (thalamus, insula, frontal lobe, hippocampal/parahippocampal cortex). CONCLUSIONS Lesion-associated AIWS in type B patients could be related to brain damage in visual pathways located preferentially, but not exclusively, in the right hemisphere. Conversely, the lesion location disparity in cases with somesthetic symptoms suggests underlying structural/functional disconnections requiring further evaluation.
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Affiliation(s)
| | | | | | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS NEUROMED, Pozzilli, IS, Italy
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21
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Personalization of medical treatments in oncology: time for rethinking the disease concept to improve individual outcomes. EPMA J 2021; 12:545-558. [PMID: 34642594 PMCID: PMC8495186 DOI: 10.1007/s13167-021-00254-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/01/2021] [Indexed: 12/12/2022]
Abstract
The agenda of pharmacology discovery in the field of personalized oncology was dictated by the search of molecular targets assumed to deterministically drive tumor development. In this perspective, genes play a fundamental "causal" role while cells simply act as causal proxies, i.e., an intermediate between the molecular input and the organismal output. However, the ceaseless genomic change occurring across time within the same primary and metastatic tumor has broken the hope of a personalized treatment based only upon genomic fingerprint. Indeed, current models are unable in capturing the unfathomable complexity behind the outbreak of a disease, as they discard the contribution of non-genetic factors, environment constraints, and the interplay among different tiers of organization. Herein, we posit that a comprehensive personalized model should view at the disease as a "historical" process, in which different spatially and timely distributed factors interact with each other across multiple levels of organization, which collectively interact with a dynamic gene-expression pattern. Given that a disease is a dynamic, non-linear process - and not a static-stable condition - treatments should be tailored according to the "timing-frame" of each condition. This approach can help in detecting those critical transitions through which the system can access different attractors leading ultimately to diverse outcomes - from a pre-disease state to an overt illness or, alternatively, to recovery. Identification of such tipping points can substantiate the predictive and the preventive ambition of the Predictive, Preventive and Personalized Medicine (PPPM/3PM). However, an unusual effort is required to conjugate multi-omics approaches, data collection, and network analysis reconstruction (eventually involving innovative Artificial Intelligent tools) to recognize the critical phases and the relevant targets, which could help in patient stratification and therapy personalization.
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22
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Brigo F, Zanchin G, Martini M, Lorusso L. Jean-Martin Charcot (1825-1893) and the "Alice in Wonderland syndrome". Neurol Sci 2021; 43:2141-2144. [PMID: 34379237 DOI: 10.1007/s10072-021-05531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
The "Alice in Wonderland syndrome" (AIWS) is a neurological disorder characterized by altered body schema perception, visual, or somesthetic symptoms, which is frequently associated with migraine. In this article, we present the earliest known description of symptoms attributable to AIWS in the medical literature. During a lecture held on November 22, 1887, at the Salpêtrière, Jean-Martin Charcot (1825-1893) examined a patient with somesthetic symptoms (partial macrosomatognosia) in the context of migraine with aura. Although this condition was not known at the time, Charcot tried to provide an accurate semiological and nosographic framework of this case, attributing the complex of symptoms to migraine with aura and epilepsy with sensory symptoms. With intellectual honesty and clinical prudence, Charcot correctly pointed to a disturbance in the excitability of cortical areas responsible for processing and perceiving sensory stimuli.
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Affiliation(s)
- Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Via Rossini, 5, 39012, Merano-Meran, Italy.
| | - Giorgio Zanchin
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Mariano Martini
- Department of Health Sciences, University of Genoa, Genoa, Italy
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23
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Infectious causes of Alice in Wonderland syndrome. J Neurovirol 2021; 27:550-556. [PMID: 34101086 DOI: 10.1007/s13365-021-00988-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/21/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
Alice-in-Wonderland syndrome (AIWS) is a perceptual disorder embracing a spectrum of self-experienced paroxysmal body image illusions including most commonly distortions of shape (metamorphopsia), size (macropsia or micropsia), distance (pelopsia or teleopsia), movement, and color among other visual and somesthetic distortions. Depersonalization, derealization, and auditory hallucinations have also been described. Recent reports suggest that infectious diseases are the predominant etiology for AIWS, especially among children. This article reviews current understanding regarding the association between infection and development of AIWS.
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24
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Hadjikhani N, Vincent M. Visual Perception in Migraine: A Narrative Review. Vision (Basel) 2021; 5:20. [PMID: 33924855 PMCID: PMC8167726 DOI: 10.3390/vision5020020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Migraine, the most frequent neurological ailment, affects visual processing during and between attacks. Most visual disturbances associated with migraine can be explained by increased neural hyperexcitability, as suggested by clinical, physiological and neuroimaging evidence. Here, we review how simple (e.g., patterns, color) visual functions can be affected in patients with migraine, describe the different complex manifestations of the so-called Alice in Wonderland Syndrome, and discuss how visual stimuli can trigger migraine attacks. We also reinforce the importance of a thorough, proactive examination of visual function in people with migraine.
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Affiliation(s)
- Nouchine Hadjikhani
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, 41119 Gothenburg, Sweden
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25
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Mastria G, Mancini V, Cesare MD, Puma M, Alessiani M, Petolicchio B, Viganò A, Di Piero V. Prevalence and characteristics of Alice in Wonderland Syndrome in adult migraineurs: Perspectives from a tertiary referral headache unit. Cephalalgia 2021; 41:515-524. [PMID: 33167711 DOI: 10.1177/0333102420968245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Migraine affects how the brain processes sensory information at multiple levels. The aberrant integration of visual and somatosensory stimuli is thought to underlie Alice in Wonderland Syndrome, a disorder often reported as being associated with migraine. However, there is still a lack of knowledge about the epidemiology of this syndrome in migraineurs and the association between Alice in Wonderland Syndrome episodes and migraine attacks. Therefore, we conducted a prospective cohort study to systematically evaluate the prevalence and the clinical features of Alice in Wonderland Syndrome in a large sample of patients with migraine. METHODS All the patients attending for the first time a tertiary-level headache clinic were consecutively screened for Alice in Wonderland Syndrome symptoms by means of an ad hoc questionnaire and detailed clinical interview, over a period of 1.5 years. Patients experiencing Alice in Wonderland Syndrome symptoms were contacted for a follow-up after 8-12 months. RESULTS Two hundred and ten patients were recruited: 40 patients (19%) reported lifetime occurrence of Alice in Wonderland Syndrome, 90% of whom (38/40) had migraine with aura. Thirty-one patients experienced episodes of Alice in Wonderland Syndrome within 1 h from the start of migraine headache. Patients reported either visual or visual and somatosensory symptoms (i.e. somatosensory symptoms never presented alone). We collected the follow-up details of 30 patients with Alice in Wonderland Syndrome, 18 of whom had been prescribed a preventive treatment for migraine. After 8-12 months, 5 of the treated patients reported a decrease, while 13 reported no episodes of Alice in Wonderland Syndrome. CONCLUSION Alice in Wonderland Syndrome prevalence in migraineurs was found to be higher than expected. Alice in Wonderland Syndrome was mostly associated with migraine with aura and tended to occur close to the migraine attack, suggesting the existence of a common pathophysiological mechanism. Patients treated with migraine preventive treatments had a higher chance of decreasing or even resolving Alice in Wonderland Syndrome episodes.
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Affiliation(s)
- Giulio Mastria
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,My Space Lab, Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Valentina Mancini
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Marco Di Cesare
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | - Marta Puma
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | - Michele Alessiani
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | - Barbara Petolicchio
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | | | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain - UCADH, Pavia, Italy
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Abstract
Illusions and hallucinations are commonly encountered in both daily life and clinical practice. In this chapter, we review definitions and possible underlying mechanisms of these phenomena and then review what is known about specific conditions that are associated with them, including ophthalmic causes, migraine, epilepsy, Parkinson's disease, and schizophrenia. We then discuss specific syndromes including the Charles Bonnet syndrome, visual snow syndrome, Alice in Wonderland syndrome, and peduncular hallucinosis. The scientific study of illusions and hallucinations has contributed significantly to our understanding of how eye and brain process vision and contribute to perception. Important concepts are the distinction between topologic and hodologic mechanisms underlying hallucinations and the involvement of attentional networks. This chapter examines the various ways in which pathological illusions and hallucinations might arise in relation to the phenomenology and known pathology of the various conditions associated with them.
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Affiliation(s)
- Clare L Fraser
- Department of Ophthalmology, Save Sight Institute, Faculty of Health and Medicine, University of Sydney, Sydney, Australia.
| | - Christian J Lueck
- Department of Neurology, Canberra Hospital, and Australian National University Medical School, Canberra, Australia
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27
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Dugauquier A, Bidgoli S. Methylphenidate-associated Alice in Wonderland syndrome. Eur J Ophthalmol 2020; 32:1120672120978882. [PMID: 33295214 DOI: 10.1177/1120672120978882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We describe the case of a child affected by typical symptoms of Alice in Wonderland syndrome (AIWS), related to the methylphenidate treatment he was taking for an attention deficit hyperactivity disorder (ADHD). To our knowledge, this is the first case of methylphenidate-associated AIWS. METHODS Retrospective single center observational case report. CASE DESCRIPTION A 12-year-old boy was complaining of micropsias and macropsias. Except a disruptive ADHD treated by methylphenidate for 2 years, his medical history was banal. His symptoms coincided with a change in his treatment regimen and ceased with methylphenidate discontinuation. Unfortunately, they recurred when the medication was reimplemented by his psychiatrist. The ophthalmological examination was unremarkable. We concluded to an AIWS and prescribed ancillary testing (including blood work, electroencephalogram, and brain MRI) to rule out conditions known to be associated with this syndrome. In the meanwhile, the methylphenidate dosage was readapted, and the symptoms disappeared again. Seen this clear dechallenge and rechallenge effect and the fact that all additional tests returned normal results, we deduced that our patient's symptoms were associated to methylphenidate. CONCLUSION AIWS could be a potential side effect of methylphenidate. Given the frequency of methylphenidate prescription for ADHD and its widespread misuse, it is important to consider this peculiar adverse effect. Every physician should be aware of the condition to offer reassurance and to prescribe the appropriate additional examinations, as life-threatening disorders can cause this syndrome.
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Affiliation(s)
| | - Sina Bidgoli
- Service d'Ophtalmologie, Hôpital Erasme, Brussels, Belgium
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28
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ElTarhouni AH, Beer L, Mouthon M, Erni B, Aellen J, Annoni JM, Accolla E, Dieguez S, Chabwine JN. The right thalamic ventral posterolateral nucleus seems to be determinant for macrosomatognosia: a case report. BMC Neurol 2020; 20:393. [PMID: 33115435 PMCID: PMC7594440 DOI: 10.1186/s12883-020-01970-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Background Macrosomatognosiais the illusory sensation of a substantially enlarged body part. This disorder of the body schema, also called “Alice in wonderland syndrome” is still poorly understood and requires careful documentation and analysis of cases. The patient presented here is unique owing to his unusual macrosomatognosia phenomenology, but also given the unreported localization of his most significant lesion in the right thalamus that allowed consistent anatomo-clinical analysis. Case presentation This 45-years old man presented mainly with long-lasting and quasi-delusional macrosomatognosia associated to sensory deficits, both involving the left upper-body, in the context of a right thalamic ischemic lesion most presumably located in the ventral posterolateral nucleus. Fine-grained probabilistic and deterministic tractography revealed the most eloquent targets of the lesion projections to be the ipsilateral precuneus, superior parietal lobule,but also the right primary somatosensory cortex and, to a lesser extent, the right primary motor cortex. Under stationary neurorehabilitation, the patient slowly improved his symptoms and could be discharged back home and, later on, partially return to work. Conclusion We discuss deficient neural processing and integration of sensory inputs within the right ventral posterolateral nucleus lesion as possible mechanisms underlying macrosomatognosia in light of observed anatomo-clinical correlations. On the other hand, difficulty to classify this unique constellation of Alice in wonderland syndrome calls for an alternative taxonomy of cognitive and psychic aspects of illusory body-size perceptions. Supplementary information Supplementary information accompanies this paper at 10.1186/s12883-020-01970-3.
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Affiliation(s)
- Amir H ElTarhouni
- Division of Neurorehabilitation, Fribourg Hospital, Meyriez, Switzerland
| | - Laura Beer
- Division of Neurorehabilitation, Fribourg Hospital, Meyriez, Switzerland
| | - Michael Mouthon
- Neurology Unit, Department of Neuroscience and Movement Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée, 5, CH-1700, Fribourg, Switzerland
| | - Britt Erni
- Division of Neurorehabilitation, Fribourg Hospital, Meyriez, Switzerland
| | - Jerome Aellen
- Department of Radiology, Fribourg Hospital, Riaz, Switzerland
| | - Jean-Marie Annoni
- Neurology Unit, Department of Neuroscience and Movement Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée, 5, CH-1700, Fribourg, Switzerland
| | - Ettore Accolla
- Neurology Unit, Department of Neuroscience and Movement Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée, 5, CH-1700, Fribourg, Switzerland
| | - Sebastian Dieguez
- Neurology Unit, Department of Neuroscience and Movement Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée, 5, CH-1700, Fribourg, Switzerland
| | - Joelle N Chabwine
- Division of Neurorehabilitation, Fribourg Hospital, Meyriez, Switzerland. .,Neurology Unit, Department of Neuroscience and Movement Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée, 5, CH-1700, Fribourg, Switzerland.
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Hossain MM. Alice in Wonderland syndrome (AIWS): a research overview. AIMS Neurosci 2020; 7:389-400. [PMID: 33263077 PMCID: PMC7701374 DOI: 10.3934/neuroscience.2020024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Alice in Wonderland syndrome (AIWS) is a rare neuropsychiatric condition characterized by distorted visual perceptions, body schema, and experience of time. A global overview of research on AIWS can inform future developments and clinical practice in this field. This bibliometric study aimed to analyze the characteristics of the global research landscape on AIWS. METHODS Bibliometric data on AIWS related publications published until 2019 were retrieved from the Web of Science database. The data were analyzed using statistical and scientometric tools to evaluate the publication trends, key research domains, top contributing journals, institutions, and countries associated with AIWS-related research. RESULTS A total of 125 published items were analyzed with a mean of 3 authors and 8.15 citations per document. Most articles were published after 2008, in medical journals focused on neuropsychiatric sciences, and most institutions affiliated with AIWS research were based on high-income countries. Major research domains associated with AIWS included visual disturbances, body image, migraine, infections, risk factors, and other clinical correlates. Several overarching domains were identified; however, clinical research on diagnosis, treatment, and prognosis of AIWS is relatively limited. CONCLUSION The current research landscape informs a developing trend in AIWS research in selected regions and specialties. Future research should emphasize multidisciplinary and translational investigations on clinical and epidemiological areas through global collaborations that may advance the knowledge and practice on AIWS.
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Affiliation(s)
- Md Mahbub Hossain
- Nature Study Society of Bangladesh, Khulna 09000, Bangladesh
- EviSyn Health, Khulna 09000, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA
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30
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Vilela M, Fernandes D, Salazar T, Maio C, Duarte A. When Alice Took Sertraline: A Case of Sertraline-Induced Alice in Wonderland Syndrome. Cureus 2020; 12:e10140. [PMID: 33005552 PMCID: PMC7524018 DOI: 10.7759/cureus.10140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Alice in Wonderland syndrome (AIWS) is a rare disorder that refers to episodic body image distortions, sometimes associated with altered perception of external space and time. AIWS is mainly associated with viral disease in children as well as migraines and epileptic seizures in adults. Its pathogenesis is still very much unknown and there are not many reported drug-associated cases in medical literature. We describe a case of a 67-year-old woman, with a relevant history of depressive disorder, nontoxic goiter, and dyslipidemia that presented short episodes of altered body perception associated with altered external space perception for a period of one week. Her physical examination was unremarkable and her cerebral computerized axial tomography (cerebral CAT) and blood tests showed no alterations. She had been medicated with sertraline till the previous year and had restarted it in the previous month. She reported similar episodes of body image distortions in the first weeks of initiating sertraline for the first time. The current episode lasted for two weeks and in one year follow-up she reported no recurrence. The patient was diagnosed with AIWS probably induced by sertraline, being the first reported case of the kind.
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Affiliation(s)
- Maria Vilela
- Internal Medicine, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
| | - Diana Fernandes
- Internal Medicine, Centro Hospitalar Do Médio Ave, Vila Nova de Famalicão, PRT
| | - Tatiana Salazar
- Internal Medicine, Centro Hospitalar Do Médio Ave, Vila Nova de Famalicão, PRT
| | - Cláudia Maio
- Internal Medicine, Centro Hospitalar Do Médio Ave, Vila Nova de Famalicão, PRT
| | - Augusto Duarte
- Internal Medicine, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
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31
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Viganò A, Mancini V, Mastria G, Di Piero V. Is it Useful to Do a Taxonomy of Complex Visual Symptoms in Migraine? A Comment on Coining the Pablo Picasso Syndrome. Headache 2020; 60:1200-1201. [DOI: 10.1111/head.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Valentina Mancini
- Centre Hospitalier Universitaire Vaudois (CHUV) My Space Lab Department of Clinical Neuroscience University of Lausanne Lausanne Switzerland
| | - Giulio Mastria
- Developmental Imaging and Psychopathology Laboratory University of Geneva School of Medicine Geneva Switzerland
| | - Vittorio Di Piero
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
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32
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Viganò A, Maestria G, Mancini V, Piero VDI. Adding pieces to the Alice in wonderland syndrome puzzle: a comment to the paper by Brooks and colleagues. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:242-243. [PMID: 32294752 DOI: 10.1590/0004-282x20190194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/15/2019] [Indexed: 06/11/2023]
Affiliation(s)
| | - Giulio Maestria
- University of Lausanne, Centre Hospitalier Universitaire Vaudois (CHUV), My Space Lab, Department of Clinical Neuroscience, Lausanne, Switzerland
| | - Valentina Mancini
- University of Geneva School of Medicine, Developmental Imaging and Psychopathology Laboratory, Geneva, Switzerland
| | - Vittorio DI Piero
- Sapienza Università di Roma, Dipartimento di Neuroscienze Umane, Roma, Italia
- Consorzio Universitario per i Disordini Adattativi e la Cefalea, Pavia, Italia
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33
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Soldan SS, Lieberman PM. Epstein-Barr Virus Infection in the Development of Neurological Disorders. ACTA ACUST UNITED AC 2020; 32:35-52. [PMID: 33897799 DOI: 10.1016/j.ddmod.2020.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epstein-Barr Virus (EBV) is a ubiquitous human herpesvirus that contributes to the etiology of diverse human cancers and auto-immune diseases. EBV establishes a relatively benign, long-term latent infection in over 90 percent of the adult population. Yet, it also increases risk for certain cancers and auto-immune disorders depending on complex viral, host, and environmental factors that are only partly understood. EBV latent infection is found predominantly in memory B-cells, but the natural infection cycle and pathological aberrations enable EBV to infect numerous other cell types, including oral, nasopharyngeal, and gastric epithelia, B-, T-, and NK-lymphoid cells, myocytes, adipocytes, astrocytes, and neurons. EBV infected cells, free virus, and gene products can also be found in the CNS. In addition to the direct effects of EBV on infected cells and tissue, the effect of chronic EBV infection on the immune system is also thought to contribute to pathogenesis, especially auto-immune disease. Here, we review properties of EBV infection that may shed light on its potential pathogenic role in neurological disorders.
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34
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Brooks JBB, Prosdocimi FC, Rosa PBD, Fragoso YD. Alice in Wonderland syndrome: "Who in the world am I?". ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:672-674. [PMID: 31553398 DOI: 10.1590/0004-282x20190094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/23/2019] [Indexed: 11/21/2022]
Abstract
Alice in Wonderland syndrome (AIWS) is a paroxysmal, perceptual, visual and somesthetic disorder that can be found in patients with migraine, epilepsy, cerebrovascular disease or infections. The condition is relatively rare and unique in its hallucinatory characteristics. OBJECTIVE To discuss the potential pathways involved in AIWS. Interest in this subject arose from a patient seen at our service, in which dysmetropsia of body image was reported by the patient, when she saw it in her son. METHODS We reviewed and discussed the medical literature on reported patients with AIWS, possible anatomical pathways involved and functional imaging studies. RESULTS A complex neural network including the right temporoparietal junction, secondary somatosensory cortex, premotor cortex, right posterior insula, and primary and extrastriate visual cortical regions seem to be involved in AIWS to varying degrees. CONCLUSIONS AIWS is a very complex condition that typically has been described as isolated cases or series of cases.
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Affiliation(s)
| | - Fabio César Prosdocimi
- Universidade Metropolitana de Santos, Departamento de função e estrutura; Santos SP, Brasil
| | | | - Yara Dadalti Fragoso
- Multiple Sclerosis & Headache Research Institute, Santos SP, Brasil.,Universidade Metropolitana de Santos, Departamento de Neurologia, Santos SP, Brasil
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35
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Raucci U, Della Vecchia N, Ossella C, Paolino MC, Villa MP, Reale A, Parisi P. Management of Childhood Headache in the Emergency Department. Review of the Literature. Front Neurol 2019; 10:886. [PMID: 31507509 PMCID: PMC6716213 DOI: 10.3389/fneur.2019.00886] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/30/2019] [Indexed: 12/16/2022] Open
Abstract
Headache is the third cause of visits to pediatric emergency departments (ED). According to a systematic review, headaches in children evaluated in the ED are primarily due to benign conditions that tend to be self-limiting or resolve with appropriate pharmacological treatment. The more frequent causes of non-traumatic headache in the ED include primitive headaches (21.8–66.3%) and benign secondary headaches (35.4–63.2%), whereas potentially life-threatening (LT) secondary headaches are less frequent (2–15.3%). Worrying conditions include brain tumors, central nervous system infections, dysfunction of ventriculo-peritoneal shunts, hydrocephalus, idiopathic intracranial hypertension, and intracranial hemorrhage. In the emergency setting, the main goal is to intercept potentially LT conditions that require immediate medical attention. The initial assessment begins with an in-depth, appropriate history followed by a complete, oriented physical and neurological examination. The literature describes the following red flags requiring further investigation (for example neuroimaging) for recognition of LT conditions: abnormal neurological examination; atypical presentation of headaches: subjective vertigo, intractable vomiting or headaches that wake the child from sleep; recent and progressive severe headache (<6 months); age of the child <6 years; no family history for migraine or primary headache; occipital headache; change of headache; new headache in an immunocompromised child; first or worst headache; symptoms and signs of systemic disease; headaches associated with changes in mental status or focal neurological disorders. In evaluating a child or adolescent who is being treated for headache, physicians should consider using appropriate diagnostic tests. Diagnostic tests are varied, and include routine laboratory analysis, cerebral spinal fluid examination, electroencephalography, and computerized tomography or magnetic resonance neuroimaging. The management of headache in the ED depends on the patient's general conditions and the presumable cause of the headache. There are few randomized, controlled trials on pharmacological treatment of headache in the pediatric population. Only ibuprofen and sumatriptan are significantly more effective than placebo in determining headache relief.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicoletta Della Vecchia
- Department of Pediatrics, University of "Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Chiara Ossella
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Chiara Paolino
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
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36
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Gündüz Ş. Metaphorising knowledge management: “ALICE in Wonderland”. KNOWLEDGE MANAGEMENT RESEARCH & PRACTICE 2019. [DOI: 10.1080/14778238.2019.1589398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Şafak Gündüz
- Faculty of Business and Management Sciences, Maltepe Universitesi, Istanbul, Turkey
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37
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Entezami P, Paul A, Adamo MA, Boulos AS. Transient Episode of Alice in Wonderland Syndrome After Ventriculoatrial Shunt Revision. World Neurosurg 2019; 121:149-151. [DOI: 10.1016/j.wneu.2018.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
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38
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Mastria G, Mancini V, Viganò A, De Sanctis R, Letteri F, Toscano M, Di Piero V. Temporal-occipital glioblastoma presenting with Alice in Wonderland Syndrome in a patient with a long-time history of migraine without aura. Neurocase 2018; 24:242-244. [PMID: 30599804 DOI: 10.1080/13554794.2018.1562079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Alice in Wonderland Syndrome (AIWS) is a rare perceptual disorder characterized by an erroneous perception of the body or the surrounding space. AIWS may be caused by different pathologies, ranging from infections to migraine. We present the case of a 54-year-old man, with a long-time history of migraine without aura, diagnosed with AIWS due to a glioblastoma located in the left temporal-occipital junction. To date, this is the first case of AIWS caused by glioblastoma. This case suggests that to exclude aura-mimic phenomena, a careful diagnostic workup should always be performed even in patients with a long-time history of migraine.
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Affiliation(s)
- Giulio Mastria
- a Department of Human Neurosciences , "Sapienza" University of Rome , Rome , Italy
| | - Valentina Mancini
- a Department of Human Neurosciences , "Sapienza" University of Rome , Rome , Italy
| | - Alessandro Viganò
- a Department of Human Neurosciences , "Sapienza" University of Rome , Rome , Italy.,b Department of Anatomy, Histology, Forensic Medicine, Orthopaedics , Sapienza University of Rome , Rome , Italy
| | - Rita De Sanctis
- c Department of Medical Oncology and Hematology , Humanitas Cancer Center and Research Hospital, IRCCS, Rozzano , Milan , Italy.,d Research Hospital , IRCCS , Rozzano , Milan,Italy
| | - Federica Letteri
- a Department of Human Neurosciences , "Sapienza" University of Rome , Rome , Italy
| | - Massimiliano Toscano
- a Department of Human Neurosciences , "Sapienza" University of Rome , Rome , Italy
| | - Vittorio Di Piero
- a Department of Human Neurosciences , "Sapienza" University of Rome , Rome , Italy.,e University Consortium for Adaptive Disorders and Head Pain - UCADH , Pavia , Italy
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Paniz-Mondolfi AE, Giraldo J, Rodríguez-Morales AJ, Pacheco O, Lombó-Lucero GY, Plaza JD, Adami-Teppa FJ, Carrillo A, Hernandez-Pereira CE, Blohm GM. Alice in Wonderland syndrome: a novel neurological presentation of Zika virus infection. J Neurovirol 2018; 24:660-663. [PMID: 30105501 DOI: 10.1007/s13365-018-0645-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/04/2018] [Accepted: 04/26/2018] [Indexed: 01/21/2023]
Abstract
Zika virus (ZIKV) is a flavivirus endemic in Africa and Southern Asian countries, which has recently emerged in unprecedented epidemic proportions around the world. Although ZIKV infection is often asymptomatic or distinguished by non-specific influenza-like symptoms, an increase in its pathogenicity and biological behavior has been the hallmark of the current pandemic. Increasing evidence suggests that neurotropic strains of ZIKV have evolved from less pathogenic strains of the virus. Neurological manifestations of ZIKV infection include a spectrum of congenital and non-congenital clinical entities, however visual somatosensory perceptual disorders have not been recorded to date. Herein, we report a case of a 15-year-old female who presented with a constellation of perceptual symptoms (metamorphopsia, telopsia, and pelopsia) following acute ZIKV infection. Although such symptoms may have originated from direct viral injury, a post-ZIKV autoimmune reaction to previously unexposed neuronal surface antigens or through molecular mimicry cannot be excluded. The development of Alice in Wonderland syndrome in our patient highlights the ever-increasing expanding spectrum of neurological symptoms associated to ZIKV infection.
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Affiliation(s)
- Alberto E Paniz-Mondolfi
- Department of Infectious Diseases and Tropical Medicine, Clínica IDB Cabudare. Instituto de Investigaciones Biomédicas IDB, Barquisimeto, 3023, Lara, Venezuela. .,Laboratorio de Señalización Celular y Bioquímica de Parásitos, Instituto de Estudios Avanzados (IDEA), Caracas, Caracas, Venezuela. .,Directorate of Health, Instituto Venezolano de los Seguros Sociales (IVSS), Caracas, Venezuela.
| | - José Giraldo
- Department of Ophtalmology and Neuro-ophtalmology, Hospital Internacional Barquisimeto, Barquisimeto, Venezuela
| | - Alfonso J Rodríguez-Morales
- Colombian Collaborative Network on Zika (RECOLZIKA), Pereira, Colombia.,Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Colombia
| | - Oriana Pacheco
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Venezuelan Science Incubator, Cabudare, 3023, Lara, Venezuela.,Health Sciences Department, College of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, 3001, Lara, Venezuela
| | - Germán Y Lombó-Lucero
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Venezuelan Science Incubator, Cabudare, 3023, Lara, Venezuela.,Health Sciences Department, College of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, 3001, Lara, Venezuela
| | - Juan D Plaza
- Health Sciences Department, College of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, 3001, Lara, Venezuela.,Health Sciences Department, College of Medicine, Universidad Nacional Experimental "Francisco de Miranda", Punto Fijo, Falcón, Venezuela
| | - Fabio J Adami-Teppa
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Venezuelan Science Incubator, Cabudare, 3023, Lara, Venezuela.,Division of Neuroradiology, Department of Radiology, Clínica IDB Cabudare. Instituto de Investigaciones Biomédicas IDB, Barquisimeto, 3001, Venezuela
| | - Alejandra Carrillo
- Health Sciences Department, College of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, 3001, Lara, Venezuela.,Health Sciences Department, College of Medicine, Universidad Nacional Experimental "Francisco de Miranda", Punto Fijo, Falcón, Venezuela
| | - Carlos E Hernandez-Pereira
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Venezuelan Science Incubator, Cabudare, 3023, Lara, Venezuela.,Health Sciences Department, College of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, 3001, Lara, Venezuela
| | - Gabriela M Blohm
- Department of Biology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
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40
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King J, Leow F, Cabarkapa S, Ng C. Alice in Wonderland syndrome: An imitator of psychosis and other medical conditions. Aust N Z J Psychiatry 2018; 52:806-807. [PMID: 29551078 DOI: 10.1177/0004867418763528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joel King
- 1 Professorial Unit, The Melbourne Clinic, Richmond, VIC, Australia.,2 Department of Psychiatry, The University of Melbourne, Richmond, VIC, Australia
| | - Fiona Leow
- 3 Eating Disorders Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Chee Ng
- 1 Professorial Unit, The Melbourne Clinic, Richmond, VIC, Australia.,2 Department of Psychiatry, The University of Melbourne, Richmond, VIC, Australia
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Primary care challenges of an obscure case of "Alice in Wonderland" syndrome in a patient with severe malaria in a resource-constrained setting: a case report. BMC Infect Dis 2017; 17:789. [PMID: 29272995 PMCID: PMC5740918 DOI: 10.1186/s12879-017-2918-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND "Alice in Wonderland" syndrome (AIWS) is a rare neurological abnormality characterized by distortions of visual perceptions, body schema and experience of time. AIWS has been reported in patients with various infections such as infectious mononucleosis, H1N1 influenza, Cytomegalovirus encephalitis, and typhoid encephalopathy. However, AIWS occurring in a patient with severe malaria is less familiar and could pose serious primary care challenges in a low-income context. CASE PRESENTATION A 9-year-old male of black African ethnicity was brought by his parents to our primary care hospital because for 2 days he had been experiencing intermittent sudden perceptions of his parents' heads and objects around him either "shrinking" or "expanding". The visual perceptions were usually brief and resolved spontaneously. One week prior to the onset of the visual problem, he had developed an intermittent high grade fever that was associated with other severe constitutional symptoms. Based on the historical and clinical data that were acquired, severe malaria was suspected and this was confirmed by hyperparasitaemia on blood film analysis. The patient was treated with quinine for 10 days. Apart from a single episode of generalized tonic-clonic seizures that was observed on the first day of treatment, the overall clinical progress was good. The visual illusions completely resolved and no further abnormalities were recorded during 3 months of follow-up. CONCLUSION Symptoms of AIWS usually resolve spontaneously or after treatment of an underlying cause. In our case, the successful treatment of severe malaria coincided with a complete regression of AIWS whose aetiology was poorly-elucidated given the resource constraints. In any case, the good outcome of our patient aligns with previous reports on acute AIWS that highlight a limited need for excessive investigation and treatment modalities which are, in passing, predominantly unaffordable in resource-limited primary care settings.
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Beyond differences between the body schema and the body image: insights from body hallucinations. Conscious Cogn 2017; 53:115-121. [DOI: 10.1016/j.concog.2017.06.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/09/2017] [Accepted: 06/12/2017] [Indexed: 11/21/2022]
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