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When the world looks like a real-life Wonderland

Jasmin Aline Persch writes:

Like Alice down the rabbit hole, 6-year-old Olivia Watts sometimes sees the world through a distorted lens. Real people look as if they have magnified, telescoped heads or bodies. Sometimes it sounds like the TV’s volume was suddenly turned up. When she has these experiences — sometimes even at school — the kindergartener from Pipersville, Pa., looks as if she’s waking from a nightmare, says her mother Danielle Watts.

Diagnosed with a neurological condition known as Alice in Wonderland Syndrome, Olivia usually keeps her dreamlike visions to herself. She first complained of people and objects getting bigger last year.  Her symptoms occur in spurts lasting from seconds to 15 minutes and persist for up to two weeks, and then, they can vanish for months just as mysteriously as they occurred. These occurrences are “mini migraines exploding in [her] brain,” a neurologist explained to Olivia’s mother, who suffers from standard migraines herself.

A rare form of migraine, Alice in Wonderland Syndrome causes people to see their own bodies or those of others or everyday objects askew. It typically occurs without a headache, but is usually associated with personal or family history of standard migraines. It can  impact vision (size or depth), hearing, touch and sense of time, causing it either to seem accelerated or or slowed down.

“It’s not dangerous,” says headache expert Dr. William Young. “I’ve never met anybody who has so many that it affects their life in a severe way, once they’re reassured that it doesn’t indicate a dangerous or ominous thing.”

Young, a neurologist from the Jefferson Headache Center at the Thomas Jefferson University in Philadelphia, says millions of Americans have typical migraine aura. “We know their brains are normal, superficially.”   But, “periodically, they misbehave,” he says.

Alice in Wonderland Syndrome is similar, doctors believe, and may involve the brain's occipital lobe, which controls our vision and where migraine auras originate. Other regions in the brain may also play a part, but the exact entrance to the mind’s rabbit hole remains a mystery.

Auras, visual sensations which precede a migraine, can be triggered by stress, certain foods and wine and typically last from five to 60 minutes. The triggers of Alice in Wonderland Syndrome are lesser understood, but certain prescribed medications including migraine-preventing topiramate or a hard blow to the head can set it off.

English psychiatrist John Todd, who coined the syndrome’s name in Canadian Medical Association Journal in 1955, compared the visions to those in “the parabolic mirrors of a fun-fair.” Patients reported perceiving the body as too big or too little and that the world seemed unreal, Todd wrote.

He and other scholars speculated that Lewis Carroll, the author of “Alice’s Adventures in Wonderland” and its sequel “Through the Looking-Glass, and, What Alice Found There,” suffered from AIWS. Carroll’s diary only reveals that he had classic migraines. But that fact “arouses the suspicion that Alice trod the paths and byways of a Wonderland well known to her creator,” Todd wrote.

Sue Miller, 41, has never seen a doctor about her symptoms, but she believes she has suffered from Alice in Wonderland Syndrome since she was a child. She remembers experiencing the “little people thing” as early as age 5, often as she lay in bed at night.

“When I would look at my windows across the room, they would get tiny and look a mile away,” Miller of Wakefield, Ohio, says. “I would get scared.”

Not until she became a concerned parent of a 5-year-old son who had similar symptoms did she understand what was happening. Miller found out about Alice in Wonderland Syndrome and related support groups online.

As an adult, she doesn’t usually talk about the condition because it seems so unbelievable. “It sounds bizarre,” Miller says.

While her altered perceptions have mostly subsided,  she sometimes sees patterns pop out at her like they’re in 3-D.

Experts believe Alice in Wonderland Syndrome is probably underreported because patients like Miller are reluctant to talk about their odd experiences. About 300 in the U.S. have the condition, Young estimates. It mostly occurs in children. Among the thousands of headache patients Young has seen, only four have the syndrome.

“My [Alice in Wonderland] patients have the perception of things being wrong,” Young says. “The original descriptions were their own bodies being out of whack.”

Dr. Kathy Lee, a pediatric ophthalmologist from Boise, Idaho, says her young patients with the condition often complain about the chalkboard at school being too far away (teleopsia), which may lead to a wasted trip to the eye doctor.

“It’s not an eye problem, per se. It’s a brain interpretation of vision,” says Lee, who often just assures parents that their kids will be fine. “These (images) are generated by the brain, not the eyes.”

Treating an episode of Alice in Wonderland syndrome may be like trying to catch a harried rabbit. But medications used to prevent migraines may provide help for those with frequent episodes, Young says.

While children with Alice in Wonderland syndrome may grow out of it into regular migraines, Young says symptoms may warrant a check up for less common but more serious conditions, including epilepsy, brain tumors and encephalitis (brain infection).

“Most people should get an MRI of the brain to make sure there are no structural problems, but it’s rather unexpected that there would be,” Young says.

Olivia’s mother is relieved that her daughter’s MRI was normal and that Alice in Wonderland syndrome is non-life threatening.

In fact, the whole family plans to see Tim Burton’s “Alice in Wonderland.” However, Olivia doesn’t particularly care to see Alice grow big or small, says Danielle Watts. She has a different reason for watching the fantasy movie: “Because I want to see the white queen.”