Alice Revisits Wonderland, This Time with a Map

Marnie Loomis, ND

As an eight-year-old girl, I began to experience periodic sensory episodes. For about 20 minutes, my body felt large while everything in the room seemed small and looked very, very far away. Sometimes I had the opposite sensation, and I felt as if I were a fly on the wall of the house of a giant. The movement of others appeared to happen in disjointed spurts and not in a smooth or fluid manner. During these painless episodes, lights seemed incredibly bright.

As one can imagine, these were very stressful events. My pediatrician reported that I was simply an anxious child and that somehow my brain was becoming “cross-wired.” Even as a young diagnostician, this didn’t seem right to me. The episodes occurred while I was on the couch reading, in the classroom studying geography, or as I laid down for sleep. They did not occur during stressful times.

I was prescribed stress reduction techniques and was often sent to the nurse’s station for treatment: lying on a cot. Eventually I learned to how to wait out the symptoms, to simply close my eyes and listen to the unaltered voices around me until my view of the world was right again.

A few decades later, the parents of a seven-year-old female patient called me with an anxious report that their daughter, during a mild fever, seemed to be hallucinating. She was screaming in terror because everyone in the room seemed very far away and small. The dog terrified her because he was moving in sporadic, awkward jumps; in fact, any motion in the room seemed to completely disorient her. Her parents were, understandably, very worried.

A house call brought me to the patient in her bedroom, eyes wide in terror, pupils dilated, cheeks flushed. As I walked into the room, she yelled for me to stop moving. I asked her to close her eyes, dimmed the lights to the minimal amount, just enough to keep from bumping into furniture, and went to her side. When she opened her eyes again, she seemed somewhat relieved, but as soon as there was movement in the room she became upset again.

Her axillary temperature was the easiest to obtain and was 100.9°F. HEENT revealed 1+ postauricular lymphadenopathy, mild erythema of the soft palate, and skin that was hot to the touch. Her abdominal exam was unremarkable, as was her cardiac exam. Her parents reported no change in stool or urine habits.

Homeopathic Belladonna 30 C was administered by mouth and seemed to calm the patient considerably. Because sound was one of the only sensations not altered, I instructed the patient’s mother to sit by her side and speak gently. The patient was asked to keep her eyes closed and focus on her mother’s words. At the same time, hydrotherapy in the form of warming socks was administered.

After 10 minutes of hydrotherapy, her axillary temperature was measured to be 99.5. She appeared calm and after another five minutes she was able to open her eyes without becoming upset.

Shortly after opening her eyes, her fever spiked back up to 101.0 axillary. Belladonna 30 C was readministered and the patient calmed enough to be able to fall asleep. The warming socks were removed and repeated as soon as the wet layer of sock reached her body temperature. In total, warming socks was repeated two times.

During a follow-up appointment three days later, the patient reported that she had experienced a recurrence of the symptoms, this time without fever. However, she was able to sit quietly and wait for the sensation to pass while her mother talked to her.

A review of her family history revealed that her father had experienced sensations like this during a fever when he was about 10 years old. He remembered the ceiling looking “miles away” and his hand looking “huge.” Additionally, her mother reported a history of migraine headaches.

We discussed that their daughter was likely experiencing a phenomenon called the Alice in Wonderland Syndrome (AIWS). It is a rarely occurring group of symptoms that is usually associated with pediatric migraine but also has been reported with cases of viral encephalitis (especially Epstein-Barr), epilepsy (Evans and Rolak, 2004), and even with abuse of cough syrup (Takaoka and Takata, 1999). First named in 1952 by CW Lippman, this collection of symptoms was named for its similarities to the disorienting sensations described by the character Alice after she fell down the rabbit hole in the children’s story Alice’s Adventures in Wonderland, written by Lewis Carroll.

Interestingly, migraine researchers theorize that Carroll himself suffered from migraine headaches and that the tales told in his story of Alice were based on his own experience of migraine aura (Wirtel, 2006).

The cause of these changes is not clear. It is thought that these types of visual hallucinations, a type of metamorphopsia, may arise as a result of migrainous ischemia and irritability in the posterior parietal lobe (Evans and Rolak, 2004). One study administered SPECT brain scans to four children experiencing AIWS, two who tested positive for Epstein-Barr virus, and found that decreased cerebral perfusion areas in all patients were near the visual tract and visual cortex (Kuo et al., 1998). Another study of children with infectious mononucleosis experiencing AIWS used visual evoked potentials to show a common pathophysiologic underlying abnormality similar to those experiencing classic migraine: transient focal decreased cerebral perfusion (Lahat et al., 1999).

The parents and patient were reassured that AIWS in itself was not dangerous and that the management was no different from the management of the underlying pathology (Evans and Rolak, 2004). In this case, because of the recurrence of her symptoms without fever, fatigue, or lymphadenopathy, the working diagnosis was pediatric migraine. She responded well to a migraine protocol of treatment with 200 mg magnesium and 10 tablets of mixed homeopathic cell salts daily.

As all practitioners agree, helping a child feel better is quite a professional victory. Each experience hangs like a gold medal around your neck. In this case the victory was made even sweeter because of my own experience with such a disorienting disorder. I felt as if I had recognized another Alice and was able to say, “Hello Alice, welcome to your rabbit hole. Here is a map for you to use while you are down there, but rest assured a ladder will soon be lowered so you can climb back out.”

References

Evans R: The Alice in Wonderland syndrome, Headache 44:624-5, 2004.

Kuo YT et al: Cerebral perfusion in children with Alice in Wonderland syndrome, Pediatr Neurol 19(2):105-8, 1998.

Lahat E et al: Abnormal visual evoked potentials in children with “Alice in Wonderland” syndrome due to infectious mononucleosis, J Child Neurol 14(11):732-5, 1999.

Takaoka K, Takata T: Alice in Wonderland syndrome and Lilliputian hallucinations in a patient with a substance-related disorder, Psychopathology 32(1):47-9, 1999.

Wirtel D: “Alice in Wonderland”: a childrens book or a migraineurs diary? http://headaches.about.com/od/profiles/a/carroll_l.htm (accessed July 2006).


 

loomis picDr. Marnie Loomis is a National College of Naturopathic Medicine graduate and current teacher of nutrition. She has a general naturopathic practice in Aloha, Oregon, where she focuses on gastrointestinal disorders, women’s medicine, and meeting the health care needs of highly sensitive people. Originally from Michigan, she received her BS from Michigan State University in interdisciplinary social science, focusing on psychology and public policy. She has been involved in health care since

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