Alice In Wonderland Syndrome (AIWS)

The name of this condition was given by Dr. John Todd, an English psychiatrist, in 1955, because the syndrome has symptoms of perceptual changes similar to those experienced by the story’s protagonist, Alice. WHAT IS ALICE IN WONDERLAND SYNDROME? Other Names: Todd’s syndrome, Dysmetropsia, Lilliputian hallucinations. Alice in Wonderland Syndrome (AIWS) is a rare neurological condition that is characterized by distortion and alteration in senses and perception, causing disorientation.  AIWS can also be said to be psychological, changing the way the brain perceives things and the environment. The disorder affects the senses of sight, hearing, and touch, causing distortions in vision, body image, sensation, time, and space.  The alterations may cause objects and people to appear smaller, larger, closer, or farther than they are, space around may seem to shift or move, time may feel longer or shorter or seem to move faster or slower, and body parts may appear to change shape and size.  People of all ages can be affected by AIWS, however, research states that the condition is more frequently diagnosed in children and adolescents than in adults. AIWS is divided into 3 categories, according to the type of perceptual distortion you may be having. They include:

• Type A

Perceptual distortions in the category are related to the awareness of your own body (somatesthesia). You feel like different parts of your body are changing shape and size.

• Type B

In this category, distortions occur in the perception of your environment, things, people, and time. Things, spaces, and people appear smaller, bigger, closer, farther, higher, lower, etc.

• Type C

This category is a combination of both type A and type B. Your perception of both yourself and the people and things around you is altered. DIAGNOSIS Alice in Wonderland syndrome is not a disorder of physiology, rather, it is said to be a psychological issue that is characterized by sensory and perceptual disturbances. Due to the ephemeral nature of the syndrome’s episodes (i.e. episodes that pass quickly), AIWS is likely to be underdiagnosed as it raises little or no concern for the patients, especially when children are involved.  The nature of the syndrome makes diagnosis to be highly based on presumption rather than assertion through tests. The range of variable symptoms is broad and there are no validated criteria for the diagnosis of AIWS. If you experience some symptoms similar to those of AIWS, go see a doctor. Your doctor will review your symptoms and look into the causes of symptoms. Certain diagnostic tests carried out to ascertain the causes of the symptoms include:

• Assessment of mental health and status through psychiatry and neurology.
• Blood tests to check for infections or viruses such as EBV
• Electroencephalography (EEG); a test that measures electric activities in the brain.
• Magnetic Resonance Imaging (MRI) scan to view the image of the brain for any abnormality.

TREATMENT There is no established treatment plan for Alice in Wonderland syndrome. Every treatment and relief option is tailored at resolving what is suspected to be the cause(s) of the symptoms of AIWS. These options may include:

1. Take medications that relieve migraines such as migraine prophylaxis, calcium channel, and beta-blockers, antidepressants, etc.
2. Follow a migraine diet such as a low tyramine diet.
3. Anticonvulsants and anti-epileptics to prevent seizures and epilepsy.
4. Antibiotics and antiviral drugs to cure infections.
5. Removal of brain tumors and lesions.
6. Adequate rest
7. Medications that relieve stress and help you relax.

COMPLICATIONS There are rarely any problems or risks associated with AIWS. The only possible complication that is recorded to be experienced by AIWS patients is a migraine that develops as a result of the episodes. Also, hallucinations may tend to be another problem. The symptoms often cause disorientation, but they do not cause harm. However, AIWS is said to get better with time. PROGNOSIS The episodes of Alice in Wonderland syndrome are fleeting and this makes it hard for a specialist to study and understand the effects of the syndrome. The symptoms happen in phases of episodes happening simultaneously and interchangeably within durations of 5 to 30 minutes. The severity of these episodes vary, sometimes happening several times a day. However, the rate of the episodes reduces, and the patient experiences fewer symptoms over time. AIWS symptoms are not dangerous to human health and the syndrome tends to resolve itself and disappear after some time, often within weeks or months. AWS episodes can happen several times a day for several days in a row, and then you may not experience symptoms for several weeks or months.

Symptoms

SYMPTOMS

Alice in Wonderland syndrome is characterized by episodes of perceptual changes. These changes may not be the same in every patient has it is dependent on the type of AIWS and the person affected. 

Each symptom comes with an episode, occurring simultaneously within a duration of 5 to 30 minutes. Symptoms may include:

1. Vision Distortion: Changes in the way you see things, which can be:

• Micropsia; things appear smaller.
• Macropsia; things appear larger.
• Pelopsia; things appear closer.
• Teleopsia; things appear farther.
• Metamorphopsia; shapes and lines appear inaccurate and distorted.

1. Alternations In Body Image: Your body parts or that of people start looking different, changing in size and appearance.
2. Distortions In Sound: You may start hearing sounds and tones differently and every sound or may sound too loud or too quiet.
3. Distortion In Time: You lose a sense of time, making time feel too fast or too slow.
4. Loss Of Coordination And Muscular Strength: Your muscles feel weak and start acting up. This affects movement and walking steps.

Other symptoms include:

• Migraine
• Hallucinations
• Seizures
• Fever

Causes

CAUSES

The causes of Alice in Wonderland syndrome is not clear. Researches have linked several conditions to the syndrome, but many cases of the AIWS have been said to have no known cause.

There is a cause to believe that the presence of abnormal electrical activities in the brain bringing about an unusual flow of blood to the sections of the brain that controls senses and perception is associated with sensory hallucinations and perceptual changes. But this is just a theory that is yet to be proven for validity.

Causes that have been associated with AIWS include:

Epstein-Barr virus (EBV) and other infectious diseases such as:

• Typhoid encephalopathy
• Influenza A virus
• Streptococcus pyogenes (Scarlet fever)
• Varicella-Zoster virus
• Mycoplasma
• Mononucleosis
• Lyme neuroborreliosis, etc.

1. Migraines
2. Head trauma
3. Brain tumors
4. Acute disseminated encephalomyelitis
5. Use of psychoactive or hallucinogenic medications.
6. Lesions in the brain
7. Stroke
8. Epilepsy
9. Psychiatric/Psychology conditions.
10. Stress

The risk of having AIWS is increased when you have a family history of migraines.

FAQ

What percent of people have Alice in Wonderland syndrome?

AIWS is a condition that is uncommon and only occurs a few times in an affected person's life and resolves after some time. The study estimates that the syndrome only affects 10 to 20% of the population.

What drugs cause Alice in Wonderland syndrome?

Medications that are said to cause hallucinations and distortion in senses and perception include psychoactive and hallucinogenic drugs.

How do I get rid of Alice in Wonderland syndrome?

There is no specified treatment option for AIWS. However, the suspected causes of the syndrome can be prevented or stopped. Treating these causes may like stop AIWS or not. 

Treatment options include:

• Rest
• Migraine medications and diets
• Antibiotics and antiviral drugs
• Anticonvulsants and anti epileptics
• Removal of lesions or tumors from the brain.

What triggers Alice in Wonderland syndrome?

AIWS causes are not clear because it has to do with perception. However, some cases have been linked to migraines, infectious diseases, certain medications, epilepsy, brain tumors or lesions, etc.

Is Alice in Wonderland syndrome rare?

Researches have identified AIWS as a rare neuropsychological disorder characterized by series of perceptual and sensory distortion occurring in episodes. It is stated to affect only 10 to 20% of the world's population.