Alice-in-Wonderland Syndrome in Patients with Migraine

Aims: Alice-in-Wonderland syndrome (AIWS) is a rare neuropsychological syndrome that includes paroxysmal distortion of the body schema, depersonalization, derealization, visual hallucinations, distorted sense of time, and deja vu and jamais vu experiences. Alice-in-Wonderland syndrome may be an equivalent of a migraine attack. The objective of this study was to evaluate the clinical particulars of Alice-in-Wonderland syndrome in patients suffering from migraine.

Place and Duration of Study: University Headache Clinic between June 2012 and November 2015.

Methodology: The study sample involved 14 subjects with migraine as defined in the ICHD-III-beta and AIWS (1 male and 13 females) with a mean age of 22.9±12.1 years. 13 patients had migraine with aura, and one subject had migraine without aura. All study subjects were somatically and psychiatric healthy. A specially designed and validated questionnaire was being used to assess symptoms in patients with AIWS.

Results: Alice-in-Wonderland syndrome was characteristically being developed in children and adolescents as part of a migraine aura, combined with a typical impairment of visual perception, or between attacks, and also had episodes of visual hallucinations. Older patients were characterized by only interictal, short (lasting a few seconds) phenomena, which was most commonly teleopsia.

Conclusion: The reported study indicates that Alice-in-Wonderland syndrome is a heterogeneous condition varying with different age subgroups among patients with migraine.