Micropsia

micropsia, or Alice in Wonderland syndrome (from anglicism Alice in wonderland syndrome), is a neuropsychological disorder It distorts visual perception. Those who suffer from this disorder experience distortions in the perception of objects, seeing them smaller than they really are (this is micropsia itself), macropsia (perception of objects larger than they really are), pelopsia (perception of the closest objects to what they are) or telopsy (perception of the most distant objects to what they are). Size distortion in sensory perception is also common.

This syndrome is associated with migraines, brain tumors, or the use of psychoactive drugs. It can be considered the beginning of the Epstein-Barr virus. AiWS can be caused by abnormal amounts of electrical activity resulting in abnormal blood flow in the parts of the brain that process visual perception and texture.

Anecdotal reports suggest that symptoms are common in childhood, with a high rate of people outgrowing it throughout adolescence. Micropsia appears to be a common sleep onset experience and is known to commonly arise due to sleep deprivation.

This disorder, popularly known as Alice in Wonderland syndrome, is so named because Lewis Carroll is believed to have suffered from this disease, thus drawing inspiration for his popular work.

Symptoms

Alice in Wonderland syndrome affects the sense of vision, touch and hearing, in addition to altering personal sensations and body image. Migraine headaches, nausea, dizziness, or agitation are also symptoms commonly associated with this disorder.

Individuals who suffer from it may suffer hallucinations or illusions of expansion, reduction or distortion of their own body image such as microsomatognosia (feeling that their own body or parts of it are shrinking), or macrosomatognosia (feeling that the body is shrinking). own body or parts of it are growing or increasing). These changes in perception are generally known as metamorphopsias or Charles Bonnet syndrome.

Subjects with certain neurological diseases may experience similar visual hallucinations. These hallucinations are called "lilliputians", alluding to the fictional island in the novel "Gulliver's Travels", where miniature people live.

A 17-year-old boy with the disorder described his unusual symptoms as follows: “Objects suddenly appear small and distant or large and close. I feel like I am getting smaller, shrinking, and at the same time the size of people is no bigger than my index finger (Lilliputian ratio). Sometimes I see the blind on the window or on the television going up or down, or my legs and arms swinging. Other times I hear the voices of people very loud and close or weak and far away. Occasionally I suffer from migraine attacks and associated headaches with red eyes, flashing lights and a feeling of dizziness. However, I am always aware of the intangible changes in me and my environment”.

Even if the subject's vision is not affected, they typically see objects of altered size or shape. In addition, depth perception can be altered, so perceived distances are generally incorrect. For example, a hallway may seem too long or the floor too close.

Zoopsia is an additional hallucination that can sometimes be associated with Alice in Wonderland syndrome. Zoopsies involve hallucinations of swarms of small animals (for example, ants, termites, and mice, etc.) or isolated groups of larger animals (such as giraffes or elephants). This experience of zoopsies shares a variety of conditions, such as delirium tremens.

A person affected by this disorder may lose all sense of time, a problem similar to lack of spatial perspective. Time seems to pass very slowly, similar to an experience derived from the substance LSD. At the same time, the lack of spatial and temporal perspective leads to a distorted sense of speed. For example, one may be moving very slowly in reality and yet it would appear as if one were frantically moving along a moving walkway, leading to severe and overwhelming disorientation.

Patients suffering from this disorder can frequently suffer from paranoia as a result of disturbing sound perception. This may include the amplification of soft sounds or the misinterpretation of common sounds. Similarly, some people may experience, along with high fevers, less frequent symptoms including loss of control of limbs or incoordination, memory loss, the perception of persistent body contact and sound sensations, and emotional instability.

It has been observed that patients are often reticent to describe their symptoms for fear of being diagnosed with a psychiatric disorder. However, it is often easy to rule out psychosis as people with this syndrome are generally aware that their hallucinations and distorted perception of reality are not real, and therefore have not lost touch with reality. Furthermore, younger patients with this disorder may have difficulty describing their unusual symptoms and it is therefore recommended that children be encouraged to draw the visual illusions they perceive during their episodes.

It appears that the symptoms of Alicia's syndrome do not increase in severity over the course of the disorder and, although the symptoms can intensely affect the patient's life, the disorder resolves itself within weeks or months. Also, symptoms may occur transiently during the day for short periods, although most patients describe the duration of their symptoms as between 10 seconds and 10 minutes. This, combined with the typically short duration of the disorder, suggests that Alice in Wonderland syndrome generally causes short-term disruption of normal functioning.

Although no genetic locus associated with Alicia syndrome has currently been identified, some observations suggest a genetic component. It appears to be passed from parent to child, with one case study of a grandmother, mother, son, and daughter all having this disorder. In addition, there is an established hereditary trait that is related to migraines. Examples of environmental influences on the incidence of the syndrome include use of the substance topiramate and potential dietary intake of tyramine.

However, more research is needed to establish genetic and environmental influences on Alice in Wonderland syndrome.

Etymology

This psychiatric disorder gets its name from Lewis Carroll's famous 19th-century novel, Alice's Adventures in Wonderland. In the story, Alice, the protagonist, experiences numerous situations similar to those associated with macropsia and micropsia. The exhaustive descriptions of metamorphopsia clearly depicted in the novel were the first of its kind to depict the bodily distortions associated with the condition. Some speculation suggests that Carroll wrote this story based on his own experience with bouts of micropsia, resulting from the numerous migraine headaches he is known to have suffered. It has also been suggested that Carroll may have suffered from temporal lobe epilepsy.

Causes

Full and partial forms of Alice in Wonderland syndrome exist in a variety of disorders, including epilepsy, intoxicants, infectious states, fevers, and brain lesions. Similarly, the syndrome is commonly associated with migraines, in addition to the use of psychoactive drugs. It may also be the initial symptom of the Epstein-Barr virus, and a potential relationship between the syndrome and mononucleosis has been suggested. Among children the Epstein-Barr virus appears to be a more common cause than among adults, among whom it is more associated with migraines.

In addition, there are a number of brain hypotheses that may explain the cause of this disorder. Alice syndrome can be caused by abnormal amounts of electrical activity causing abnormal blood flow in the parts of the brain that process visual perception and texture. Nuclear medical techniques using technetium, performed on patients during episodes of Alice in Wonderland syndrome, have shown that it is associated with reduced cerebral perfusion in various cortical regions (frontal, parietal, temporal, and occipital), both in combination and in isolation. It has been hypothesized that any condition that results in decreased perfusion of the visual pathways or visual control centers of the brain may be responsible for the syndrome. For example, one study used single photon emission computed tomography to demonstrate reduced cerebral perfusion in the temporal lobe in patients with the syndrome. Other theories suggest that the syndrome is the result of nonspecific cortical dysfunction (eg, from encephalitis, epilepsy, decreased cerebral perfusion) or reduced blood flow to other areas of the brain. Other theories suggest that disordered perceptions of body image stem from the parietal lobe. This has been demonstrated by the production of body image disturbances through electrical stimulation of the posterior parietal cortex. On the other hand, other investigators suggest that metamorphopsias may be the result of reduced perfusion of the non-dominant posterior parietal lobe during migraine episodes. In all neuroimaging studies, various cortical regions (including the temporoparietal junction within the parietal lobe and the visual pathway, specifically the occipital lobe) are associated with the development of Alice in Wonderland syndrome symptoms.

Diagnosis

Alice in Wonderland syndrome is a perceptual disturbance rather than a specific physiological change in body systems. The diagnosis can be proposed when other causes have been ruled out and if the patient presents with symptoms along with migraines and complains of their occurrence during the day (although it can also occur at night). As there are no established diagnostic criteria for the Alice in Wonderland syndrome, there is likely to be a high degree of variability in the diagnostic process and therefore it is likely to be misdiagnosed.

Treatment

Alice in Wonderland syndrome currently does not have a standardized treatment plan. Often, treatment methods revolve around migraine prophylaxis, as well as promoting a low-tyramine diet. Medications that may be used to prevent migraines include: anticonvulsants, antidepressants, calcium channel blockers, and beta blockers. Other treatments that have been explored include repetitive transcranial magnetic stimulation (rTMS). However, more research is required to establish an effective treatment regimen.

First of all, rest is the main treatment, but another effective therapy is to join support groups to share experiences and know that you are not alone.