Alice in Wonderland syndrome is a neurological condition that causes perceptual disturbances. This can include sight, touch, and time.

Another name for Alice in Wonderland syndrome (AIWS) is Todd’s syndrome. It is a rare condition that temporarily changes how the brain perceives things.

An English psychiatrist called John Todd named the syndrome in 1955. The name comes from Lewis Carroll’s book, Alice’s Adventures in Wonderland, in which the protagonist, Alice, experiences situations similar to those that occur with this condition.

AIWS can affect people at any age, but research suggests that it mainly occurs in children and adolescents.

In this article, we discuss what AIWS is, its symptoms and causes, and the treatment options available.

a small door on a tree to illustrate Alice in wonderland syndromeShare on Pinterest
A person with AIWS may experience perceptual disturbances.

AIWS can affect the way a person perceives:

  • sight
  • hearing
  • touch
  • sensation
  • time

The most common visual distortions are micropsia, in which a person sees objects as smaller than they are, and teleopsia, where objects appear farther away than they are in reality.

There are three main categories of AIWS, which differ according to the type of perceptual disorder.

The categories are:

  • Type A, where disorders are somesthetic, or sensory
  • Type B, which affects visual senses
  • Type C, which is a mix of types A and B

The authors of a 2016 article state that type A follows the original definition of AIWS, which involves people feeling as though their body parts are changing size.

Type B causes more visual distortions of the surrounding environment.

A person with Type B AIWS may experience:

  • micropsia, where objects appear too small
  • macropsia, where objects appear too big
  • metamorphopsia, where aspects of shapes, such as height and width, appear inaccurate
  • pelopsia, where objects appear too close
  • teleopsia, where objects appear farther away than they are

A person with Type C AIWS can perceive both the image of their own body and that of other people or things around them to be changing.

According to a 2012 study, there are more cases of Type B in young individuals and more cases of Type C in adults.

The symptoms of AIWS depend on its type and the person it affects.

They may include:

  • distorted body image
  • altered perception of time
  • metamorphopsia
  • distorted perception of size

Symptoms that accompany an episode may include:

  • feverish symptoms
  • migraine episodes
  • epileptic seizures that affect only part of the brain

According to a 2016 review, the most common causes of AIWS appear to be migraines and Epstein-Barr virus infections.

Some other infectious diseases that can cause AIWS include:

  • influenza A virus
  • mycoplasma
  • varicella-zoster virus
  • Lyme neuroborreliosis
  • typhoid encephalopathy
  • streptococcus pyogenes, also known as scarlet fever and tonsillopharyngitis

Other causes may include:

  • brain lesions
  • medication
  • psychiatric conditions
  • epilepsy
  • stroke

According to a 2014 case study, brain tumors may cause temporary AIWS.

Head trauma may also be a possible cause.

The course of treatment for AIWS depends on the underlying cause.

If migraine is the source of the condition, doctors may suggest managing migraine through diet and preventive medication. However, if epilepsy is causing the symptoms, a doctor may prescribe antiepileptics. If an infection is responsible, they may offer antiviral agents.

According to a 2016 systematic review, doctors rarely prescribe antipsychotics because, despite the nature of the syndrome, there is no psychosis in AIWS.

Antipsychotics can also increase the chances of epileptic activity, possibly making a person’s condition worse.

There are no formally established criteria for diagnosing AIWS, and the range of potential symptoms is broad.

When diagnosing AIWS, the doctor reviews the symptoms that the person is experiencing in a manner that helps them feel comfortable.

The doctor can then look for the causes of each symptom and assess how they link together.

Tests for diagnosing AIWS may include:

  • neurological and psychiatric consultation to assess mental status
  • routine blood testing
  • MRI scans to provide an image of the brain
  • electroencephalography (EEG), which tests electrical activity in the brain and can help doctors identify epilepsy
  • additional assessments

A person should seek medical attention if they are experiencing any of the symptoms above, even if episodes are short.

A doctor may find an underlying cause that was not previously clear. Identifying a cause will make it easier to reduce the severity of the symptoms.

AIWS can be uncomfortable, but the condition resolves itself without further complications in almost two–thirds of cases.

Alice in Wonderland syndrome is a rare disorder that causes disorientation and distorted perception.

It features disruption to the way in which a person perceives their senses and body image, other things around them, or the passing of time. The syndrome mostly affects children, but symptoms can begin at any point in life.

Treatment is not direct but relies on identifying and treating underlying causes.

The criteria for diagnosis remain unclear, as researchers do not yet understand many aspects of the syndrome. They need to carry out more studies before they can determine whether an effective, direct treatment is possible.