Alice In Wonderland Syndrome Explained. 2023
Alice in Wonderland Syndrome Explained
Reverend Charles Lutwidge Dodgson (1832-1898) better known by his pen name, Lewis Carroll, was an English writer, mathematician, clergyman, and early photographer. His most famous writings are Alice’s Adventures in Wonderland and the sequel Through the Looking-Glass.
Reverend Charles Dodgson
Reverend Dodgson suffered from migraine with aura and he projected the strange suffering of his own malady upon his characters, most typically Alice.
Alice in Wonderland Syndrome can have features where the individual sees things very big (macropsia) or very small (micropsia). Other medical conditions are also associated with the Alice in wonderland syndrome.
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This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, the American Headache Society, migraine textbook author, podcaster, YouTube video producer, and blogger.
Alice in Wonderland Syndrome (AIWS), known as dysmetropsia and as Todd’s syndrome, is a neuropsychological disorder that causes a distortion of visual perception. Affected persons notice that images appear smaller (micropsia). larger (macropsia), closer (pelopsia), or farther away (teleopsia) than they actually are.
Alice in Wonderland Syndrome (AIWS) causes alteration of the sensations of vision and spatial location and is associated with persons who have migraine with aura, brain tumors, epilepsy, psychoactive drug use, sleep onset and lack of sleep, and Epstein-Barr infection.
The syndrome is characterized by body-image distortion and disordered perception of distance, size, shape and spatial relationship between objects.
The sensations of altered vision and space were described by Reverend Dodgson in his book, Alice’s Adventures in Wonderland, by Alice as she fell down the rabbit hole.
Related questions.
Who was Alice? Alice was Alice Pleasance Hargreaves (née Liddell), 1852-1934), who was, in her childhood, a friend of Lewis Carroll, the penname for Charles Dodgson and, the writer of Alice’s Adventures in Wonderland.
Alice Lidell
One of the stories Dodgson told her during a boating trip became the children's classic 1865 novel Alice's Adventures in Wonderland.
Who was Charles Dodgson (1832-1898? He was born in Daresbury, a village in northwest England, the third child of an Anglican clergyman. He had 10 siblings and did not lack for company.
Wakeling, who annotated his diaries said, “He told his brothers and sisters stories, made up games and wrote magazines with them.”
From an early age, Dodgson wrote poetry and short stories, which were published in the family magazine Mischmasch and later in other magazines producing for him moderate success.
Professionally he was a professor of mathematics at Christ Church Oxford.
.He used the name Lewis Carroll for his fiction producing his most famous stories:
Alice’s Adventures in Wonderland and Through the Looking-Glass, and What Alice Found There.
His poems The Jabberwock and The Hunting of the Snark were not as famous. He wrote 11 books on mathematics, and 12 works of literary fiction.
He was described as a man who enjoyed entertaining children “and they loved him in return.”
Throughout his life he kept his mathematical writings, all published under his real name,
Reverend Charles Dodgson separate from his fiction, for which he used the penname Lewis Carroll.
What medical problems did Reverend Dodgson have? Charles Dodgson suffered from chronic migraine with aura, epilepsy, the speech impediment of stammering, partial deafness, trouble with facial recognition, lumbago, recurring infectious diseases, synovitis, and ADHD.
Although he claimed excellent health, he actually had many medical problems that bothered him for periods of time.
Did Charles Dodgson have migraine?
It is not clear what age he was when his migraine started. Migraine is considered to a familial, genetically inherited, polygenic neurologic problem.
The idea that Charles Dodgson had migraine is supported by his diaries. He described five attacks of migraine with vomiting. Interestingly, the current International Classification of Headache Disorders 3 requires “five headaches” to make a valid diagnosis of migraine.
He often reported a “bilious headache” with severe vomiting. “Bilious attack” is a phrase that refers to migraine in England.
In a diary entry in 1880, Dodgson discussed experiencing his first episode of migraine with aura. In 1885 he wrote he “experienced, for the second time, that odd optical affection of seeing moving fortifications, followed by a headache.”
Fortification is a term referring to migraine aura visual images wherein the migraineur sees rectangle box like images similar to the top of the wall of a fort.
Because of this visual problem he consulted an eminent ophthalmologist, William Bowman in 1865, five years before writing Alice. He also published in his family journal a figurative representation of a person with the right half of the face, shoulder, and hand erased, compatible with a right paracentral negative scotoma, typical of migraine's visual aura see Podoll, K. and Robinson, D. (1999) Out-of-Body Experiences and Related Phenomena in Migraine Art. Cephalalgia, 19, 886-896.
Did Reverend Dodgson’s migraine experience affect his writing?
It is assumed, although never clearly stated, that the unusual migrainous symptoms Alice suffered in her journey through the rabbit hole were suffered also personally by Reverend Dodgson.
How else would he have known to write about migraine symptoms in such an illustrious and fascinating fashion, unless he had migraine?
Who was Todd?
Blom, JD, wrote in Neurol Clin Pract. 2016 Jun; 6(3): 259–270 on Alice in Wonderland Syndrome and provided a review of the history of the disorder:
“The term Alice in Wonderland syndrome was introduced in 1955 by the British psychiatrist John Todd (1914–1987) to cover a group of symptoms “… intimately associated with migraine and epilepsy, although not confined to these disorders.”
As envisioned by Todd, the group comprised derealization, depersonalization, hyperschematia, hyposchematia, and somatopsychic duality, as well as illusory changes in the size, distance, or position of stationary objects in the visual field; illusory feelings of levitation; and illusory alterations in the sense of the passage of time.
Incidentally, Todd was well aware that he was not the first to describe those individual symptoms. Many of them had appeared before in the literature on hysteria, on general neurology, and on soldiers with occipital wounds after World Wars I and II.
Moreover, in 1933 and 1952, Coleman and Lippman, respectively, had already drawn comparisons between those symptoms and the experiences of Alice in Wonderland, albeit without turning the name into an eponym.
Lippman was also the first to suggest that the bodily changes experienced by Alice might well be inspired by body schema illusions Lewis Carroll had experienced himself. Carroll (pseudonym of the British mathematician Charles Lutwidge Dodgson, 1832–1898) had migraines, and his diaries indicate that his attacks were sometimes preceded by aural phenomena.
However, historians consider Lippman's hypothesis inconclusive, as the diaries fail to demonstrate that Dodgson experienced any aural phenomena before he wrote his book. An alternative hypothesis is that Dodgson had knowledge of—or perhaps had experimented with—the hallucinogenic mushroom Amanita muscaria.
Whatever the exact course of events may have been, with Alice in Wonderland, Dodgson created a character that appealed as much to physicians as it did to the book's intended audience. And Todd, by adopting the name, chose a memorable moniker for a group of symptoms hitherto described in isolation of each other.
Entries in Alice’s Adventures in Wonderland that relate to AIWS.
“She was considering in her own mind (as well as she could, for the hot day made her feel very sleepy and stupid.)”
Migraine may be brought on or worsened by heat.
“The rabbit-hole went straight on like a tunnel for some way, and then dipped suddenly down, so suddenly that Alice had not a moment to think about stopping herself before she found herself falling down a very deep well.”
Migraine auras are commonly described as “like a tunnel,” or having “tunnel vision.” Migraine patients often times faint or have syncope which comes with the sense of “falling.”
“What a curious feeling!” said Alice; I must be shutting up like a telescope.” And so it was indeed: she was now only ten inches high.”
“I’m opening out like the largest telescope that ever was! Good-bye, feet! (for when she looked down at her feet, they seemed to be almost of sight, they were getting so far off). Oh, my poor little feet, I wonder who will put on your shoes and stocking for you now, dears? I’m sure I shan’t be able! I shall be a great deal too far off to trouble myself about you.”
“Just then her head struck against the roof of the hall: in fact she was now more than nine feet high.”
Migraine patients may describe largeness or smallness of their visual perception.
Migraine may cause feeling part of or the whole body as larger (macrosomatognosia) or smaller (microsomatognosia) than usual.
Macropsia is a neurological condition affecting human visual perception, in which objects within an affected section of the visual field appear larger than normal, and micropsia is just the opposite-objects appear smaller than normal.
Macropsia cause the person to feel smaller than they actually are and micropsia, larger than they are.
Palinopsia (Greek: palin for "again" and opsia for "seeing") is the persistent recurrence of a visual image after the stimulus has been removed.
Teleopsia is a vision perception disorder, in which objects appear much farther away than they are. Teleopsia is a disorder associated with dysmetropsia (Any of the group of visual illusions involving an alteration in the size or separation of perceived object).
Teleopsia relates to Alice’s far off feet.
Alice’s neck getting longer
Alice growing bigger
“Curiouser and curiouser!” cried Alice (she was so much surprised, that for the moment she quite forgot how to speak good English.
“oh dear, how puzzling it all is! I’ll try if I know all the things I used to know. Let me see: four times five is twelve, and four times six is thirteen, and four times seven is—oh dear! I shall never get to twenty at that rate! However, the Multiplication Table doesn’t signify: let’s try. Geography.
London is the capital of Paris, and Paris is the capital of Rome, and Rome—no, that’s all wrong, I’m certain! I must have been changed for Mabel! I’ll try and say ‘How doth the little—‘ and she crossed her hands on her lap as if she were saying lessons, and began to repeat it, but her voice sounded hoarse and strange, and the words did not come the same as they used to do:”
Alice experienced aphasia while in the woods, "where things lacked names". She knew a tree, but could not name it, and couldn’t remember her own name.
Migraine patients may have aphasia, which means trouble naming or producing normal speech. They may also have “confusional migraine,” wherein they are very confused.
There was no label this time with the words ‘DRINK ME,’ but nevertheless she uncorked it and put it to her lips. ‘I know something interesting is sure to happen, ’she said to herself, ‘whenever I eat or drink anything; so I’ll just see what this bottle does. I do hope it’ll make me grow large again, for really I’m quite tired of being such a tiny little thing!’
Alice drinking to change size.
It did so indeed, and much sooner than she had expected: before she had drunk half the bottle, she found her head pressing against the ceiling, and had to stoop to save her neck from being broken. She hastily put down the bottle, saying to herself ‘That’s quite enough—I hope I shan’t grow anymore—As it is, I can’t get out at the door—I do wish I hadn’t drunk quite so much!’
Alas! it was too late to wish that! She went on growing, and growing, and very soon had to kneel down on the floor: in another minute there was not even room for this, and she tried the effect of lying down with one elbow against the door, and the other arm curled round her head. Still she went on growing, and, as a last resource, she put one arm out of the window, and one foot up the chimney, and said to herself ‘Now I can do no more, whatever happens. What will become of me?’
Migrainous distortion of body parts and space, macropsia.
“As she said this, she looked up, and there was the Cat again, sitting on a branch of a tree.
‘Did you say pig, or fig?’ said the Cat.
‘I said pig,’ replied Alice; ‘and I wish you wouldn’t keep appearing and vanishing so suddenly: you make one quite giddy.’
‘All right,’ said the Cat; and this time it vanished quite slowly, beginning with the end of the tail, and ending with the grin, which remained sometime after the rest of it had gone.
‘Well! I’ve often seen a cat without a grin,’ thought Alice; ‘but a grin without a cat! It’s the most curious thing I ever saw in my life!’
The Cheshire Cat with his luminous C shaped smile.
This Cheshire Cat’s smile is like the description of a luminous, bright, C shaped arc that flickers or exudes light. It is a migrainous aura that comes and goes. When it disappears, it is like a scotoma or a blind spot, all typical of migrainous auras.
“Where the noise came from, she couldn’t make out: the air seemed full of it, and it rang through and through her head till she felt quite deafened.”
Alice experienced sensitivity to sound, called sonophobia (fear of sound):
Etiology of Alice in Wonderland Syndrome.
There are multiple etiologies of Alice in Wonderland Syndrome, which is thought to reflect either abnormal cerebral perfusion or cortical spreading depression.
AIWS Etiologies:
Headaches
Migraine
Abdominal migraine
Cluster headache
Tension type headache
HANDL: syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis
Epilepsy
Complex partial epilepsy
Frontal lobe epilepsy
Infectious diseases
Epstein-Barr virus
Coxsackie B1 virus
Cytomegalovirus
Influenza A virus
Mycoplasma
Varicella-zoster
Typhoid encephalopathy
Lyme neuroborreliosis
Streptococcus pyogenes (scarlet fever and tonsillopharyngitis)
Parainfective vasculitis
Cerebrovascular diseases
Intraparenchymal hemorrhagic stroke
Ischemic stroke
Cavernous angioma
Robin Hood syndrome
Pituitary infarction
Other organic brain diseases
Acute disseminated encephalomyelitis
Glioblastoma
Psychiatric disorders
Depressive disorder
Cotard Syndrome
Capgras Syndrome
Schizophrenia
Schizoaffective disorder
Drugs
Dextromethorphan
Cough syrup (containing dihydrocodeine and DL-methylephedrine)
Montelukast
Topiramate
LSD
Hallucinogen Persisting Perception Disorder (HPPD) after LSD withdrawal
Toluene-based solvent
Case reports of Alice In Wonderland Syndrome etiology
Evans RW. Wrote in Headache. 2006 May;46(5):815-8. on Reversible palinopsia and the Alice in Wonderland syndrome associated with topiramate use in migraineurs.
Two patients are reported who developed palinopsia while taking topiramate for migraine prevention which resolved or decreased in frequency or duration on lower doses, but recurred or increased in frequency or duration on higher doses. Both patients had complete resolution of palinopsia when topiramate was discontinued. A third patient is described who developed the "Alice in Wonderland" syndrome about 1 week after starting topiramate for migraine prevention with complete resolution of symptoms about 1 month after stopping. Topiramate use may cause palinopsia and may be associated with the Alice in Wonderland syndrome through an unknown mechanism.
Mastria, et al, writing in Biomed Res Int. in 2016 on Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review stated:
Out of 166 cases of AIWS published, the most common cause is migraine (27.1%), followed by infections (22.9%), principally EBV (15.7%).
In decreasing order, other etiologies are as follows: brain lesions (7.8%), medicament (6%) and drugs (6%), psychiatric disorders (3.6%), epilepsy (3%), disease of the peripheral nervous system (1.2%), and others (3%).
In about 20% of patients no cause of AIWS was found.
What is the pathophysiology of the Alice in Wonderland Syndrome?
AIWS symptoms relate to ischemia or cortical spreading depression of temporopariental-occipital brain regions.
Ischemia refers to decrease in the amount of oxygenated arterial blood.
Cortical Spreading Depression (CSD) of Leão refers to a short-lasting depolarization wave that in patients with migraine with aura moves across the cortex at a rate of 3–5 mm/min. A brief phase heralds the reaction which is immediately followed by prolonged nerve cell depression synchronously with a dramatic failure of brain ion homeostasis, efflux of excitatory amino acids from nerve cells and enhanced energy metabolism.
Mastria, et al, stated that:
Alice in Wonderland Syndrome (AIWS) is a perceptual disorder, principally involving visual and somesthetic integration, firstly reported by Todd, on the literary suggestion of the strange experiences described by Lewis Carroll in Alice in Wonderland books.
Symptoms may comprise among others aschematia and dysmetropsia, migraine, and AIWS, which could be considered in many patients as an aura or a migraine equivalent, particularly in children.
Nevertheless, AIWS seems to have anatomical correlates. According to neuroimaging, temporoparietal-occipital carrefour (TPO-C) is a key region for developing many of AIWS symptoms. The final part of this review aims to find the relationship between AIWS symptoms, presenting a pathophysiological model.
In brief, AIWS symptoms depend on an alteration of TPO-C where visual-spatial and somatosensory information are integrated.
Alterations in these brain regions may cause the co-occurrence of dysmetropsia and disorders of body schema.
In our opinion, the association of other symptoms reported in literature could vary depending on different etiologies and the lack of clear diagnostic criteria.
A SPECT study revealed hypoperfusion in the temporal-occipital lobe and perisylvian area during the acute stage of AIWS.
Interestingly, an fMRl study during an episode of micropsia in a child with AIWS revealed contemporary hypoactivation in occipital lobe and hyperactivation in the right superior parietal cortex.
Moreover, in the same study, when a size comparison-based visual task was used in the same patient with micropsia, hyperactivation of right superior and bilateral inferior parietal cortices was found.
Medical cases with Alice in Wonderland Syndrome symptoms.
Nabil Kitchener wrote on Alice in Wonderland Syndrome in The International Journal of Child Neuropsychiatry. Vol.1 (1) Sep. 2004. His Case #1 is presented.
A previously well 9-year-old boy with Sudden onset of strange sensations:
Illusions of size and shape of the blackboard in his classroom, (micropsia and distortion)
Disappearance of color of objects, including chalk and dress, then,
Decrease in size of his head and left upper limb.
He was alternately very tall or shrinking, then his left hand became huge.
Sounds were abnormally loud, all of these followed by throbbing headache.
During episodes, patient was alert, but slightly disoriented to place (where am I?).
Episodes last approximately 15 minutes and occurred twice per week for 1 month before diagnosis.
No history of seizures, psychiatric disorder, head trauma, nor infection.
No medicines, or street drugs
Family History: migraine
General, neurological, psychiatric, and ophthalmological examinations were all unremarkable.
Lab and head CAT scan were normal.
EEG showed right tempro-parietal epileptogenic discharge.
He received a conventional antiepileptic and complete resolution as AED at a full dose was reached.st
Proved to suffer from complex partial seizures.
Mastria, et al, ibid from above reported:
…the first that used the term of Alice in Wonderland Syndrome (AIWS) was Todd, in 1955. He described six cases (four were migraineurs), reporting mainly somesthetic symptoms of feeling part of or the whole body as larger (macrosomatognosia) or smaller (microsomatognosia) than usual.
These symptoms were also associated with either visual illusions, including dysmetropsia, namely, macropsia and micropsia (objects or other people appearing bigger or smaller) and telopsia and pelopsia (objects or other people appearing respectively further or nearer), or disorders of consciousness, as feelings of derealization, depersonalization, somatopsychic duality (i.e., the idea to be split in two, more often vertically in the middle), and alteration in judgment of time.
Some other symptoms that have been reported within the spectrum of AIWS are kinetopsia, auditory hallucinations and verbal illusions, hyperacusia/hypoacusia, dyschromatopsia, zoopsia, and complex visual hallucinations
William Gowers in 1907 reported that patients with seizures experienced "feelings of unreality in what is seen."
Hermann Oppenheim in 1913 wrote that a patient with "violent" migraine had "indescribable feelings of detachment of trunk or an extremity".
McDonald Critchley noted that patients with migraine or seizures arising in their parietal lobes perceived objects as smaller (micropsia) or larger (macropsia)than they were.
Caro Lippman in 1952 claimed that he was first to describe migraine patients with hallucinations of their body splitting in half and the remaining half shrinking or growing excessively large. Lippman proposed that Lewis Carroll, Charles Dodgson's nom de plume, described his own migraine related illusions in "Alice's Adventures in Wonderland" in 1865 to entertain Alice Liddell, daughter of his Dean at Christ Church College, Oxford, England.
Ali Ulvi Uca and Hasan Hüseyin Kozak reported in the Balkan Med J. in 2015 Jul; 32(3): 320–322 on The Alice in Wonderland Syndrome: A Case of Aura Accompanying Cluster Headache
Cluster headache (CH) is a primary headache which has highly specific and sensitive criteria, and not presence of an aura.
It has been recently reported that CH may not presence with aura more than ever and this condition will be identified by headache specialists as a new form of CH.
As there is no report to our knowledge on Alice in Wonderland syndrome (AIWS) manifested as CH aura in the literature, we present a case of a 35-year-old man having AIWS as CH aura.
Clinically, AIWS is not uncommon and is likely to be underestimated as a diagnostic entity. Valproate may be preferred for treatment in CH patients with AIWS aura.
Auras have been described to occur in association with cluster headache (CH), hemicrania continua, even with chronic paroxysmal hemicrania. In chronic CH, auras have been reported in 20% of patients.
We describe a 35-year-old man with Alice in Wonderland syndrome (AIWS) manifested as aura of CH.
Case Presentation
A thirty-five-year-old male patient with a four-year history of episodic CH has been examined in the outpatient clinic. Pain attacks repeated 3–5 times a day, lasting 0.5–1 hour for 3–4 weeks, with no pain noted for 1 year afterwards. Pain was defined to be localized on the left orbital and peri-orbital region. The headache was defined by the patient to have a severe and throbbing nature, co-existing with ipsilateral conjunctival hyperemia and nasal congestion.
During the attacks, the patient indicated receiving subcutaneous sumatriptan and used methylprednisolone as prophylactic treatment.
The pain attacks commencing in this era were different compared to others, manifested as a perception of enlargement of the left side of the head, a length increase in left-side extremities, a slowing-down of overall movements, surrounding objects appearing to be far away/smaller, color changes of the self and surrounding objects such as hair or dress, lasting 2–5 minutes just before headache onset.
At that instant, the patient perceives himself as a giant with a great amount of fear. The patient has been re-oriented to the psychiatry clinic with AIWS findings interpreted to be psychiatric, from the emergency service he applied to after his post-aural headache. He had no family history of migraine or any other neurological disorders.
The patient did not have any history of drug abuse, depression, or psychiatric illness.
Workup including blood work, EEG, and MRI scan were normal.
The patient was first treated with methylprednisolone, but didn’t respond until Valprote was added and the dose increased to 1000 mg/day. After that he was headache and visual aura free following follow up for 3 months.
Frequency of Alice in Wonderland Syndrome (AIWS)
Epstein-Barre Virus infection is the most common cause in children. Migraine attacks occur in adults.
The syndrome is rare, and no good statistical data exists to document frequency.
Mastria, et al, writing in Biomed Res Int. in 2016 on Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review stated: AIWS remains a poorly known and a probably misdiagnosed syndrome.
Dooley, et al, wrote on Review of Alice in Wonderland Syndrome in Pediatr Neurol in 2014 Sep;51(3):321-3.
The authors followed up 28 pediatric headache patients.
Patients who were observed by one of the authors in 1983 were contacted by telephone in 1993, 2003, and 2013.
Details were gathered regarding the presence and characteristics of ongoing headaches and about the presence of sleepwalking, motion sickness, and distortions of either time or space perceptions.
Results. Ongoing headaches were reported by 71%. Sleepwalking was only present in one patient in 2013. More than a third still complained of motion sickness, and more than one quarter still experienced distortions of time.
Distortions of space were still reported by nearly 20%. Reporting any of these phenomena was not consistent over time, with some patients reporting distortions for the first time in adulthood. There was no clear correlation with migraine, and patients with tension-type headaches also reported the phenomena.
Epidemiology of AIWS
Due to rarity of occurrence the epidemiology of AIWS is not possible to report. There is a problem with the standard classification of Alice in Wonderland Syndrome which limits statements regarding epidemiology. It is not clear what is Alice in Wonderland Syndrome and what is not.
The exact prevalence of the AIWS is unknown. There are no large-scale epidemiologic studies.
Genetic link
The genetics of AIWS only relates to migraine which is familial and polygenic. The most common cause of AIWS, Epstein-Barre Viral Syndrome is not genetically related.
Sexual preference
One study of Japanese adolescents found the occurrence of micropsia and macropsia was 6.5% in boys and 7.3% in girls
There is no sexual preference for Epstein-Barre Viral Syndrome, but migraine occurs in 25% of women and 3 times more frequently in women than men.
Age affected
In 65% of cases AIWS occurred in children under 18 years of age.
Neurologic workup
A complete medical and specific neurologic history oriented around migraine and Epstein-Barre syndrome and physical exam should be done. Testing such as blood work, CAT or MRI scan should be done.
Patients with AIWS have showed abnormal perfusion in medial temporal, hippocampus, tempro-occipital or tempro-parieto-occipital regions.
Case report with special functional MRI scanning.
Brumm K, et al, wrote in Headache. 2006 May;46(5):815-8 on Functional magnetic resonance imaging of a child with Alice in Wonderland syndrome during an episode of micropsia.
Alice in Wonderland syndrome is a perceptual disorder involving brief, transient episodes of visual distortions (metamorphopsia) and can occur in conjunction with certain viral infections. We used functional magnetic resonance imaging to examine visual processing in a 12-year-old boy with viral-onset Alice in Wonderland syndrome during an episode of micropsia (reduction in the perceived size of a form).
Results:
In both tasks, the child with Alice in Wonderland syndrome showed reduced activation in primary and extrastriate visual cortical regions but increased activation in parietal lobe cortical regions as compared with a matched control participant.
Conclusions:
The active experience of micropsia in viral-onset Alice in Wonderland syndrome reflects aberrant activity in primary and extrastriate visual cortical regions as well as parietal cortices. The disparate patterns of activity in these regions are discussed in detail.
Duration of attack
Epstein-Barre Viral Syndrome has a duration of 2 to 4 weeks, although symptoms of AIWS don’t last that long in those patients. Migraine headache can last 4-72 hours but aura symptoms should be less than 60 minutes.
Partial Complex Seizures usually last less than 30 minutes.
Usual AIWS symptoms are transient and last less than 30 minutes.
Treatment
The associated condition should be treated if possible, for example, anticonvulsant treatment with valproate stopped symptoms in a young boy with AIWS and partial complex seizure cited by Brumm, et al earlier, but there is no specific treatment for many of the symptoms of AIWS.
Prognosis
The prognosis of AIWS symptoms is good. The symptoms are transient and usually resolve leaving no lasting symptoms or residua.
The problem is counselling and relieving anxiety in affected patients, which are usually children and their parents.
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Britt Talley Daniel MD