Alice in Wonderland Syndrome (AIWS) is a unique and interesting condition that has captured the attention of many. If you want to learn more about this topic, this article will provide you with a comprehensive and insightful overview of AIWS, including its symptoms, causes, and treatments.
AIWS is a neurological condition in which a person's perception of reality is temporarily altered. People with AIWS may experience a range of symptoms, including distorted perceptions of size, shape, and distance. The exact cause of AIWS is unknown, but it is frequently associated with migraines, epilepsy, psychiatric disorders, or the use of some drugs.
If you're interested in learning more about Alice in Wonderland Syndrome, keep on reading. We have some more interesting information to share with you, including a more detailed explanation of the symptoms, the various theories on its causes, and what are the AIWS treatments available.
The term "Alice in Wonderland syndrome" (AIWS) was first used by John Todd in 1955, inspired by Lewis Carroll's 1865 novel "Alice's Adventures in Wonderland".1 AIWS is a neurological condition that temporarily alters an individual's perception of reality. People with AIWS may experience a range of symptoms that affect their perception of size, shape, and distance. For example, objects may appear distorted in size or the perception of distance may be altered. In addition to these distortions in size and distance perception, some individuals with AIWS may also experience an altered perception of the passage of time passage an illusory feeling of levitation.
The exact cause of AIWS is not fully understood, but it is often associated with several factors, including migraines, epilepsy, psychiatric disorders, or the use of some types of drugs. AIWS can also occur as a side effect of certain medications and a range of other illnesses. Despite the temporary nature of the condition, AIWS can be a confusing and disorienting experience for those who suffer from it. However, with proper medical care, the symptoms of AIWS can usually be managed and treated effectively.
Causes of AWIS
AIWS is a rare neurological syndrome that disrupts how the brain processes sensory input. The majority of AIWS symptoms are attributed to specific neurons and cell columns within the central nervous system that respond only to specific sensory stimuli.2 Some of the most commonly reported causes for Alice in Wonderland Syndrome include
- Headaches: Such as migraines, abdominal migraines, cluster headaches, tension-type headaches and HaNDL syndrome
- Epilepsy: Both temporal and frontal lobe epilepsy
- Infectious diseases: Including Epstein Barr Virus, Lyme Disease and, influenza, among others
- Cerebrovascular diseases: Including haemorrhagic stroke, ischaemic stroke, cavernoma and Robin Hood syndrome3
- Brain diseases: Such as acute disseminated encephalomyelitis and glioblastoma
- Psychiatric disorders: Including depressive disorders, schizophrenia and schizoaffective disorder, among others
- Drugs and medications: AIWS can also occur as a side effect of certain drugs, which include dextromethorphan and DL-Methylephedrine (found in cough syrups), dihydrocodeine (an opioid painkiller), as well as LSD and other narcotics4
Signs and symptoms of AWIS
In the last six decades, AIWS symptoms have come to include 42 visual symptoms and 16 other nonvisual symptoms. All of these symptoms share the characteristic of being alterations in sensory perception rather than being classified as hallucinations or illusions.4 Some of the most common symptoms and signs of Alice in Wonderland syndrome include:1
- Micropsia: Objects may appear smaller than they are
- Macropsia: Objects may appear larger than they are
- Pelopsia: Objects may appear closer than they are
- Teleopsia: Objects may appear farther away than they are
- Metamorphosia: Objects may appear too fat, thin, short, or tall
- Altered perceptions: In some cases, people with AIWS may also experience an altered perception of time passage or an illusory feeling of levitation
Management and treatment for AIWS
As yet, there is no treatment available for Alice in Wonderland Syndrome. Nonetheless, most nonclinical and clinical cases of AIWS are considered benign, meaning that the symptoms often decrease spontaneously or with proper treatment of underlying conditions. However, in cases where a chronic condition such as migraine or epilepsy is present, the symptoms may reappear during active phases of the disease. 4
When deciding on the management and treatment strategy, it will be important to assess the situation carefully and understand the natural course of any other underlying conditions. When treatment is necessary, it should target the suspected underlying condition. This can usually involve the prescription of antiepileptics, migraine prophylaxis, antivirals, or antibiotics. For example, if the problem is caused by migraines, the treatment of the migraine itself may be the best alternative to alleviate AIWS symptoms.5 Additionally, when distortions are experienced as comorbid symptoms in patients with psychosis, it is important to consider the possibility that antipsychotics may induce or exacerbate these symptoms.3
How common is AIWS?
The exact prevalence of AIWS remains uncertain due to several factors. Firstly, there is a lack of large-scale epidemiological studies on the subject. Secondly, the absence of universally accepted diagnostic criteria for AIWS raises questions about the accuracy of reported data, which should be evaluated with caution. However, a study of Japanese teenagers aged 13 to 18 years found that the occurrence of micropsia and macropsia was 6.5% in boys and 7.3% in girls, indicating that visual illusions associated with AIWS may not be uncommon in the general population.6
How is AIWS diagnosed?
The accuracy of diagnosing AIWS relies primarily on obtaining a comprehensive medical history, conducting a thorough physical examination including a neurological evaluation and possibly otologic (hearing) or ophthalmic (visual) evaluations, and having a solid understanding of the diverse symptoms of AIWS and their potential causes.3 Your healthcare provider may also perform blood tests, EEG (electroencephalography) and/ or a brain MRI (magnetic resonance imaging) scan.
How can I prevent AIWS?
The occurrence of Alice in Wonderland Syndrome is uncertain and the reasons behind it are yet to be fully comprehended by specialists. As a result, Alice in Wonderland syndrome can hardly be prevented because most of the time it is caused by other underlying conditions that can’t be prevented, such as migraines, viral infections, epilepsy or psychiatric disorders.
Who is at risk of AIWS?
This syndrome is uncommon and when it does occur, it typically has a brief duration and resolves quickly. Although there is a lot more to learn about AIWS, it seems that people who have migraines or epilepsy are more likely to experience the syndrome, as well as, younger children and teenagers.4
What can I expect if I have AIWS?
If you ever deal with Alice in Wonderland Syndrome, you may experience a range of symptoms that include distorted perceptions of size, shape, and distance. Some people may also experience an altered perception of time passage, hallucinations or a feeling of levitation.1
When should I see a doctor?
If you are experiencing symptoms of Alice in Wonderland Syndrome for the first time, it is important that you seek medical attention promptly, because AIWS can be an indication of underlying important or serious medical conditions.
In summary, AIWS is an uncommon disorder which is usually the result of other illnesses or a reaction to drugs or medications. AIWS is most likely to occur in teenagers or young adults. Although the causes of AIWS are largely unknown, underlying conditions such as epilepsy, migraines and infection may have a causative role in AIWS. If you think you or someone you know may be experiencing AIWS, seeking medical advice is highly recommended.
- Gogia Rastogi et al. R. Migrainous aura, visual snow, and “alice in wonderland” syndrome in childhood. Elsevier [Internet]. 2016; Disponível em: http://dx.doi.org/10.1016/j.spen.2016.01.006
- Mastria G, Mancini V, Viganò A, Di Piero V. Alice in wonderland syndrome: a clinical and pathophysiological review. Biomed Res Int [Internet]. 2016 [citado 10 de fevereiro de 2023];2016:8243145. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223006/
- Kumar M, Khurana D, Choudhary A, Ahuja CK. Acute revascularization induced reversed robin hood syndrome. Journal of Stroke Medicine. 2022 Jun;5(1):65-8.
- Blom JD. Alice in Wonderland syndrome. Neurol Clin Pract [Internet]. junho de 2016 [citado 10 de fevereiro de 2023];6(3):259–70. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909520/
- Paraskevas KI, Conrad MF, Schneider PA, Cambria RP. Best Medical Treatment Alone Is Adequate for the Management of All Patients With Asymptomatic Carotid Stenosis, or “Alice in Wonderland”. Angiology. 2023 May 11:00033197231174724.
- Abe K, Oda N, Araki R, IGATA M. Macropsia, micropsia, and episodic illusions in Japanese adolescents. Journal of the American Academy of Child & Adolescent Psychiatry. 1989 Jul 1;28(4):493-6.