Características y evolución de los pacientes con síndrome de Alicia en el País de las Maravillas

Infectious causes of Alice in Wonderland syndrome

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.

Time Distortions: A Systematic Review of Cases Characteristic of Alice in Wonderland Syndrome

Of the perceptual distortions characteristic of Alice in Wonderland syndrome, substantial alterations in the immediate experience of time are probably the least known and the most fascinating. We reviewed original case reports to examine the phenomenology and associated pathology of these time distortions in this syndrome. A systematic search in PubMed, Ovid Medline, and the historical literature yielded 59 publications that described 168 people experiencing time distortions, including 84 detailed individual case reports. We distinguished five different types of time distortion. The most common category comprises slow-motion and quick-motion phenomena. In 39% of all cases, time distortions were unimodal in nature, while in 61% there was additional involvement of the visual (49%), kinaesthetic (18%), and auditory modalities (14%). In all, 40% of all time distortions described were bimodal in nature and 19% trimodal, with 1% involving four modalities. Underlying neurological mechanisms are varied and may be triggered by intoxications, infectious diseases, metabolic disorders, CNS lesions, paroxysmal neurological disorders, and psychiatric disorders. Bizarre sensations of time alteration-such as time going backwards or moving in circles-were mostly associated with psychosis. Pathophysiologically, mainly occipital areas appear to be involved, although the temporal network is widely disseminated, with separate component timing mechanisms not always functioning synchronously, thus occasionally creating temporal mismatches within and across sensory modalities (desynchronization). Based on our findings, we propose a classification of time distortions and formulate implications for research and clinical practice.