Alice in Wonderland syndrome

Alice in Wonderland syndrome (AIWS, named after the novel written by Lewis Carroll), also known as Todd's syndrome, is a disorienting neurological condition which affects human perception. Sufferers may experience micropsia, macropsia, or size distortion of other sensory modalities. A temporary condition, it is often associated with migraines, brain tumors, and the use of psychoactive drugs. It can also present as the initial sign of the Epstein-Barr Virus (see mononucleosis). Anecdotal reports suggests that the symptoms of AIWS are fairly common in childhood, with many people growing out of them in their teens. It appears that AIWS is also a common experience at sleep onset.

Signs and symptoms

Eye components are entirely normal. The AIWS is a result of change in perception as opposed to the eyes themselves malfunctioning. The hallmark sign of AIWS is a migraine (AIWS may in part be caused by the migraine). AIWS affects the sufferer's sense of vision, sensation, touch and hearing, as well as one's own body image.

The most prominent and often most disturbing symptom is that of altered body image: the sufferer will find that they are confused as to the size and shape of parts of (or all of) their body.

The eyes themselves are normal, but the sufferer 'sees' objects with the wrong size or shape and/or finds that perspective is incorrect. This can mean that people, cars, buildings, etc. look smaller or larger than they should be, or that distances look incorrect; for example a corridor may appear to be very long, or the ground may appear too close.

Similar to the lack of spatial perspective, the sufferer also loses a sense of time. That is, time seems to pass very slowly, akin to an LSD experience. The lack of time, and space, perspective thus leads to a distorted sense of velocity, since one is missing the two most important parts of the equation. For example, one could be inching along ever so slowly in reality, yet it would seem as if one were sprinting uncontrollably along a moving walkway, leading to severe, overwhelming disorientation. This can then cause the sufferer to feel as if movement, even within their own home, is futile.

In addition, some people may experience more intense and overt hallucinations, seeing things that are not there and misinterpreting events and situations in conjunction with a high fever.

Diagnosis

AIWS is a disturbance of perception rather than a specific physiological change to the body's systems. The diagnosis can be presumed when other physical causes have been ruled out and if the patient presents symptoms along with migraines and complains of onset during the day (although it can occur at night). Another symptom of AIWS is sound distortion, like every little movement makes a clattering sound. This can make a person with AIWS paranoid and afraid to move.

Treatment

Treatment is the same as that for other migraine prophylaxis: anticonvulsants, antidepressants, beta blockers, and calcium channel blockers, along with strict adherence to the migraine diet. Chronic Alice In Wonderland Syndrome is untreatable and must wear itself out.

Prognosis

Whatever the cause, the distortions can recur several times a day and may take some time to abate. Understandably, the sufferer can become alarmed, frightened, and even panic-stricken. The symptoms of the syndrome themselves are not harmful and likely to disappear with time. It is not contagious and rest is the best treatment.

Epidemiology

Although no studies are available that display any correlation between age, gender or race, AIWS is thought to be relatively common among migraine sufferers and young children.

References

• PMID 12207198
• Kew, J., Wright, A., & Halligan, P.W. (1998). Somesthetic aura: The experience of "Alice in Wonderland", The Lancet, 351,p1934