Alice in Wonderland Syndrome
Alice in Wonderland Syndrome
Todd’s syndrome, more frequently referred to as Alice in Wonderland syndrome (AIWS), is a disorienting neurological condition that primarily targets children. AIWS affects human visual perception and involves an array of symptoms that include transient altered perception of the shapes of inanimate and animate objects that appear to be smaller (micropsia) or larger (macropsia) than normal. There can also be an impaired sense of passage of time or the feeling of “zooming” of the surrounding environment. The episodes are predominantly short in duration, often less than an hour, and occur up to several times a day, with unpredictable onset of symptoms. Essentially, patients suffering from AIWS experience distorted time, space, and body image. They feel as though their bodies have been altered in size and they have visual hallucinations.
Dr. John Todd, a British psychiatrist, first described AIWS in 1955. Todd gave it this name by way of the famous novel by Lewis Carroll, Alice's Adventures in Wonderland, as the illness resembles the events experienced by Alice. Reportedly, Lewis Carroll actually suffered from severe migraines and Lilliputian hallucinations, during which objects and people appear smaller than they actually are.
This rare neurological diagnosis can be confused with drug intoxication or psychosis. In Todd’s paper, he described a singular group of symptoms associated with migraine and epilepsy. Cases of AIWS have been also associated with diagnoses of infectious mononucleosis. The patients he detailed showed no signs of damaged eyesight or brain tumors. The majority of patients with AIWS report a family history of migraines or suffer from migraine themselves. Patients with AIWS have the feeling that their entire body or parts of it have been altered in shape and size.
Documented triggers for an episode of AIWS include, but are not limited to, migraine, stress, brain tumors, Epstein-Barr virus infection, drugs (particularly cough medicine), epilepsy, and infections. Episodes are of short duration and can reoccur multiple times in a day. There is no way to predict onset. Several neurologists have ordered MRIs for patients with acute-stage AIWS, though once the episode has passed, brain activity appears normal. Dr. Sheena Aurora, a Stanford neurologist and migraine specialist, was the first to perform an MRI scan of the brain of a 12-year-old patient in the middle of an episode. Dr. Aurora’s 2008 report concludes that electrical activity caused abnormal blood flow in the parts of the brain that control vision and process texture, shape, and size. “The brain of someone with Alice in Wonderland syndrome is just a little bit different from those with other auras,” she said.
There are no proven treatment methods for AIWS; however, rest and dietary changes are indicated. Most cases of AIWS are self-terminating and resolve by adulthood.
- Brumm K, Walenski M, Haist F, Robbins SL, Granet DB, Love T. Functional MRI of a child with Alice in Wonderland syndrome during an episode of micropsia. J AAPOS. 2010;14(4): 317-322. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928409/.
- Eshel GM, Eyov A, Lahat E, Brauman A. Alice in Wonderland syndrome, a manifestation of acute Epstein-Barr virus infection. Pediatr Infect Dis J. 1986;6(1):68. http://www.ncbi.nlm. nih.gov/pubmed/3822619.
- Gencoglu EA, Alehan F, Erol I, Koyuncu A, Aras M. Brain SPECT findings in a patient with Alice in Wonderland syndrome. Clin Nucl Med. 2005;30:758-759. http://www.ncbi.nlm.nih.gov/ pubmed/16237308.
- Hung KL, Liao HT, Tsai ML. Epstein-Barr virus encephalitis in children. Acta Paediatr Taiwan. 2000;41(3):140-146. http://www.ncbi.nlm.nih.gov/pubmed/10920547.
- Kuo YT, Chiu NC, Shen EY, Ho CS, Wu MC. Cerebral perfusion in children with Alice in Wonderland syndrome. Pediatr Neurol. 1998;19(2):105-108. http://www.ncbi.nlm.nih.gov/ pubmed/9744628.
- Lahat E, Berkovitch M, Barr J, Paret G, Barzilai A. Abnormal visual evoked potentials in children with “Alice in Wonderland” syndrome due to infectious mononucleosis. J Child Neurol. 1999;14(11):732-735. http://www.ncbi.nlm.nih.gov/pubmed/10593551.
- Liaw SB, Shen EY. Alice in Wonderland syndrome as a presenting symptom of EBV infection. Pediatr Neurol. 1991;7(6):464-466. http://www.ncbi. nlm.nih.gov/pubmed/1665694.
- Todd J. The syndrome of Alice in Wonderland. Can Med Assoc J. 1955;73(9):701-704. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1826192/.