Abstract

Introduction: Alice in Wonderland Syndrome (AIWS) is a rare neurologic condition first described in 1955 as a phenomena involving a myriad of perceptual distortions and depersonalization, similar to those experience by Alice in the Lewis Carrol novel. AIWS has been associated with various brain pathologies, the most common being migraine in adults and infections in children. It is usually self limited, but can take months-years and there is no known treatment. To our knowledge, this is the first and only case report demonstrating the use of Osteopathic Cranial Manipulative Medicine (OCMM) to treat AIWS.

Case: A 15-year-old female presented to the OMM clinic for chronic, intractable headaches after suffering a concussion 3 months prior when she was hit by a softball on her right forehead. Headaches were described as “achy,” bilateral, and associated with perceptual distortions and being “out of body” (depersonalization) that occurred daily. On physical exam the patient had a severe sphenobasilar synchondrosis (SBS) compression, left lateral strain, decreased CRI motion, and right on left sacral torsion. We hypothesized that the cranial somatic dysfunctions observed may be causing/contributing to the patient’s symptoms of AIWS, which may also benefit from OCMM.

Results: After treatment, there was increased motion of the CRI, resolution of SBS compression, and our patient’s symptoms of depersonalization were completely resolved. Her headaches, while changing in location and character, were steadily improving.

Discussion: This case provides evidence for the practical utility of OCMM in the treatment of suspected AIWS, as well as suggesting an anatomical/biomechanical etiology for AIWS, which warrants further research. Limitations include few numbers of treatments and a lack of adequate follow-up time.