So sang Jefferson Airplane in their psychedelic classic White Rabbit. While this song seems sure to have been inspired by the use of certain unapproved medications, don't have to be dropping acid to feel ten feet tall.One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don't do anything at all
Go ask Alice
When she's ten feet tall
A new paper from Germany reports on a case of "Alice In Wonderland Syndrome" associated with topiramate, an anti-epileptic drug also used to prevent migraines:
Alice In Wonderland Syndrome - the feeling that parts of the body have changed in size or shape - is a symptom known to be associated with various brain disorders, although it's not clear why it happens. It can occur in migraines. However in this case, the patient had never experienced such symptoms before she started on an anti-migraine drug.A 17-year-old girl presented with a 7-year history of migraine... she was put on 50 mg topiramate at night... after 4 months the dose was further increased to 75 mg/day, as she was still having three to four headache days/month.She then reported previously unknown intermittent nocturnal distortions of her body image only on those occasions when she did not directly fall asleep after taking topiramate. She described that either her head would grow bigger and the rest of the body would shrink, or that her hand resting comfortably on her chest would increase in size and become heavier, while the remaining arm would become smaller. The patient denied any hallucinatory character of these perceptions and insisted on their unpleasant but unreal nature...After reduction of topiramate to 50 mg/day, the nocturnal phenomena ceased within 2 weeks. The neurological and psychiatric examination was normal... We agreed with the patient to a rechallenge and increased the daily dose to 75 mg/day. Two weeks later the distortions reappeared again and the patient decided to discontinue the drug.
The authors conclude that while topiramate is an "excellent" drug, it can cause unusual side effects and they say that "The prescribing physician should be aware that it has the ability to induce various adverse effects and should encourage patients to report them - even if they initially appear awkward to them."
Jürgens TP, Ihle K, Stork JH, & May A (2011). "Alice in Wonderland syndrome" associated with topiramate for migraine prevention. Journal of neurology, neurosurgery, and psychiatry, 82 (2), 228-9 PMID: 20571045
7 comments:
I used to get that as a kid (and still do sometimes as an adult but much less frequently) when falling asleep (and not on any medication). It's an odd sensation, but it never really bothered me. I do get migraines sometimes and I've also had other sleep disturbances in the past - mainly out-of-body experiences.
I think there is a lot of reckless messing about with brain chemistry going on. No-one can understand the interactions of hundreds of substances that all affect each other. Not so different to the days of insulin comas and lobotomies. A basic lack of respect for subjective integrity.
I've had AIWS all my life (now in my 40s). As a child, it would mainly happen in the dark as I was going to sleep. Later, as a teenager, I could enter the state at will after a bit of concentration, though it would always involuntarily resolve within a few minutes and had a refractory period of a day or so.
The AIWS symptoms were never accompanied by any migraine, nor did it affect my ability to perform any action (such as driving or sports.) The primary manifestation was not body image distortion, but rather, visual micropsia, a change in auditory background noise, and a mild sense of time dilation.
In my 20s, I stopped being able to command the state at will, but it would happen on its own every few months.
In my 30s, I would go years with only an occasional, fleeting occurrence, until one specific trigger--dental sedation with nitrous oxide. I went through a series of procedures that included breathing a 30/70 mixture N2O/O2. Every single time, this would instantly and strongly bring on the micropsia (but not the auditory effects.)
It must have had an long-term effect, as after a few times being reliably induced by N2O, it has never happened since on its own, and I've been symptom free for at least five years.
I get this after sex. Too much suctioning and grinding could distort perception on proportions.
Countdown till this hits the recreational drug area started....
i used to get this feeling when i was a young kid (<10) after taking large doses of Tedrol (sp?) for unsually problematic asthma attacks.
As with any psychoactive drug, the results are not the same for everybody. That's why psychiatrists have to tinker with dosages and combinations until they find levels that work for the client. It takes a good partnership between patient and doctor to work together to find the optimum dosages.
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