title: [Phenomenological and Diagnostic Implications of Paraschemazia: A Case Report].
abstract: Paraschemazia is characterized by distortions of body image, and has been observed in neurological disorders (epilepsies, migraine, and non-dominant cortical lesions), retinal damage, and hallucinogenic drug use. This complex symptom cluster of subjective and objective perceptual abnormalities forms an essential feature of Todd's Alice in Wonderland syndrome. This neuropsychiatric manifestation must be phenomenologically differentiated from hallucinations, illusions, and agnosias. Herein we report a patient with paraschemazia that occurred during the ictal phase of temporal lobe epilepsy; the patient was referred to the department of psychiatry due to symptoms of transient intense fear and abnormal perceptions. We also discuss the diagnostic difficulty and phenomenological implications associated with this rare phenomenon. A 45-year-old female presented with brief episodes (30-45 s) of sensory distortion, during which the faces and limbs of other people and her own appeared distorted (e.g. protruding eyes, elongated nose, and oval or square head). The episodes of sensory distortion were associated with intense fear and were followed by loss of consciousness for 5 min. She had been experiencing these episodes since the age of 12 years and responded poorly to several antiepileptic medications. 3-Tesla MRI performed using a complex partial seizure protocol showed altered signal intensity and volume loss in the right hippocampus, suggestive of right mesial temporal sclerosis. Neuropsychological assessment showed impaired sustained attention, working memory, and verbal and visual learning and memory, suggestive of bilateral dorsolateral prefrontal and temporal lobe deficits. She improved in response to a combination of levetiracetam and clobazam, and was seizure free at the 2-year follow-up.
authors.forename: Urvakhsh Meherwan
authors.initials: UM
authors.lastname: Mehta
authors.forename: Harish
authors.initials: H
authors.lastname: Thippeswamy
authors.forename: Rose Dawn
authors.initials: RD
authors.lastname: Bharath
authors.forename: Parthasarathy
authors.initials: P
authors.lastname: Satishcandra
mesh_terms: D003937:Diagnosis, Differential; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006212:Hallucinations / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales