Alice in Wonderland syndrome: What is it and who is at risk?

Although fewer than 200 cases have been reported in medical literature, Alice in Wonderland syndrome (AIWS) is a source of curiosity for many. Named after Lewis Carroll's "Alice's Adventures in Wonderland" in 1955, this syndrome bears many similarities to the sensations Alice experiences in the novel.

Alice follows a rabbit down a hole that brings her to Wonderland, where various foods and beverages cause her to grow and shrink until she finally returns to her normal size. But while Carroll's book is a work of fiction, AIWS is very real.

What is Alice in Wonderland syndrome?

Also known as Todd's syndrome — for English psychiatrist John Todd, who named the condition in 1955 — AIWS is a neurological disorder associated with a set of symptoms that affect how you perceive your body and the world around you. AIWS can cause you to see things as either smaller or larger than they are and affect how you perceive the passage of time and motion. For example, you may feel like time, people or objects are sped up, moving slowly or aren't moving at all.

The symptoms of AIWS can be divided into two categories: self-perception (how you view yourself) and visual perception (your brain's ability to make sense of what your eyes are seeing). AIWS symptoms tend to be temporary, lasting a few minutes to as many as 30 minutes, which may be one reason it's underreported in medical literature.

Common symptoms

While AIWS symptoms can vary from person to person and even episode to episode, these are some that are more commonly reported.

• Size distortion, in which your body or objects around you appear to be sized differently from reality. These include:
  • Micropsia – things appear to grow smaller
  • Macropsia – things appear to grow larger
• Perceptual distortion, in which the relation of objects near you appear to be different from reality. These include:
  • Pelopsia – things seem larger than they are because they appear to be closer
  • Telopsia – in which things seem smaller than they are because they appear to be farther away
• Time distortion, when time appears to be moving faster or slower than reality.
• Sound distortion, in which every sound, including those that are typically hushed, seems amplified and disruptive.
• Loss of limb control or coordination, when you may feel as if your body is moving involuntarily and you’ve lost the ability to control how you move or walk.

What causes Alice in Wonderland syndrome and who is at risk?

More research is needed to understand exactly why AIWS occurs, but several conditions are considered possible causes. Based on reported cases, the most common cause in adults is migraines. AIWS is also linked to epilepsy, central nervous system lesions, head trauma and bacterial or viral infections. Epstein-Barr infection appears to be the most common cause of AIWS in children.

Genetics may also play a part in developing AIWS. A pediatric study found a family history of migraine in nearly half of patients, suggesting a genetic predisposition.

How is Alice in Wonderland syndrome diagnosed?

Because AIWS is rare and not well understood, there's no definitive way to diagnose the condition. It may often be misdiagnosed or underdiagnosed. AIWS is a diagnosis of exclusion, meaning your healthcare provider will rule out other conditions first. If you think you have AIWS, your doctor will ask you about your symptoms and may perform a neurological or ophthalmic (eye) exam.

Some other tests your doctor may run to diagnose AIWS include:

• MRI brain scan
• Blood testing, to rule out or diagnose underlying viruses or infections
• Neurological and psychiatric consultation
• EEG, which tests electrical activity in the brain

How is Alice in Wonderland syndrome treated?

AIWS treatment depends on the cause. For example, if migraines are causing your symptoms, your doctor may recommend medication or a "migraine diet." Certain foods can trigger migraine, such as alcohol, chocolate, cured meats and monosodium glutamate (commonly known as MSG). Your doctor may prescribe antiepileptics if your AIWS is caused by epilepsy or antivirals if a viral infection is to blame.

Caring for your health

While AIWS symptoms often resolve quickly, it's important to see a doctor to rule out any underlying causes. Seeking medical attention is the best way to ensure your symptoms aren't related to a serious health condition, such as a stroke or brain infection. If you have stroke-like symptoms in addition to AIWS symptoms, seek emergency care right away. As in most cases, consulting a healthcare professional is the best way to address any health concerns and get the care you deserve.