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Vol. 44, No. 5, 2011
Issue release date: July 2011
Section title: Case Report
Psychopathology 2011;44:337–344
(DOI:10.1159/000325102)

Treatment of Alice in Wonderland Syndrome and Verbal Auditory Hallucinations Using Repetitive Transcranial Magnetic Stimulation: A Case Report with fMRI Findings

Blom J.D. · Looijestijn J. · Goekoop R. · Diederen K.M.J. · Rijkaart A.-M. · Slotema C.W. · Sommer I.E.C.
aParnassia Bavo Group, The Hague, bDepartment of Psychiatry, University of Groningen, Groningen, and cNeuroscience Division and Rudolf Magnus Institute for Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands

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Article / Publication Details

First-Page Preview
Abstract of Case Report

Received: 12/7/2009
Accepted: 1/17/2011
Published online: 7/7/2011
Issue release date: July 2011

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 2

ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)

For additional information: http://www.karger.com/PSP

Abstract

Background: Alice in Wonderland syndrome (AIWS) is a rare cluster of CNS symptoms characterized by visual distortions (i.e. metamorphopsias), body image distortions, time distortions, and déjà experiences. Verbal auditory hallucinations (VAHs) are the most prevalent type of hallucination in adults with or without a history of psychiatric illness. Here, we report the case of a woman with AIWS, long-lasting VAHs, and various additional perceptual and mood symptoms. Methods: Semi-structured interviews were used to assess symptoms, and functional MRI (fMRI) was employed to localize cerebral activity during self-reported VAHs. Treatment consisted of repetitive transcranial magnetic stimulation (rTMS) at a frequency of 1 Hz at T3P3, overlying Brodmann’s area 40. Results: Activation during VAHs was observed bilaterally in the basal ganglia, the primary auditory cortex, the association auditory cortex, the temporal poles, and the anterior cingulated gyrus. The left and right inferior frontal gyri (Broca’s area and its contralateral homologue) were involved, along with the dorsolateral prefrontal cortex. Interestingly, synchronized activation was observed in the primary visual cortex (areas V1 and V2), and the bilateral dorsal visual cortex. The higher visual association cortex also showed significant, but less prominent, activation. During the second week of rTMS treatment, not only the VAHs, but also the other sensory deceptions/distortions and mood symptoms showed complete remission. The patient remained free of any symptoms during a 4-month follow-up phase. After 8 months, when many of the original symptoms had returned, a second treatment phase with rTMS was again followed by complete remission. Conclusions: This case indicates that VAHs and metamorphopsias in AIWS are associated with synchronized activation in both auditory and visual cortices. It also indicates that local rTMS treatment may have global therapeutic effects, suggesting an effect on multiple brain regions in a distributed network. Although a placebo effect cannot be ruled out, this case warrants further investigation of the effects of rTMS treatment in AIWS.


  

Author Contacts

Jan Dirk Blom, MD, PhD
Assistant Professor of Psychiatry
Parnassia Bavo Group, Paradijsappelstraat 2
NL–2552 HX The Hague (The Netherlands)
Tel. +31 70 391 7521, E-Mail jd.blom@parnassiagroep.nl

  

Article Information

Received: December 7, 2009
Accepted after revision: January 17, 2011
Published online: July 7, 2011
Number of Print Pages : 8
Number of Figures : 1, Number of Tables : 2, Number of References : 54

  

Publication Details

Psychopathology (International Journal of Descriptive and Experimental Psychopathology, Phenomenology and Psychiatric Diagnosis)

Vol. 44, No. 5, Year 2011 (Cover Date: July 2011)

Journal Editor: Mundt C. (Heidelberg), Akiskal H.S. (San Diego, Calif.), Herpertz S. (Heidelberg)
ISSN: 0254-4962 (Print), eISSN: 1423-033X (Online)

For additional information: http://www.karger.com/PSP


Article / Publication Details

First-Page Preview
Abstract of Case Report

Received: 12/7/2009
Accepted: 1/17/2011
Published online: 7/7/2011
Issue release date: July 2011

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 2

ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)

For additional information: http://www.karger.com/PSP


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