All you need to know about: Alice in Wonderland Syndrome

Imagine drifting into a moment that feels almost like tumbling down a rabbit hole — not a literal fall, but a sudden shift when your senses betray you. One second everything is ordinary, and in the next, your teacup seems strangely oversized, the chair across the room looks unusually small, and even your own hands feel as if they’re stretching or shrinking. This surreal, topsy-turvy experience might sound like a scene from Lewis Carroll’s Alice’s Adventures in Wonderland. But for some people, it can happen in real life. Named after the classic children’s novel, Alice in Wonderland Syndrome (AIWS) is a rare neurological condition that makes a once-familiar world feel strange and distorted.

What is Alice in Wonderland Syndrome?

Alice in Wonderland Syndrome, also known as Todd’s Syndrome, is a rare neurological condition that causes temporary distortions in how a person perceives size, distance, body image, and time. The condition was formally described in 1955 by British psychiatrist John Todd, who observed patients experiencing these unusual distortions while remaining aware that they were not real. According to the Canadian Medical Association Journal, Todd’s work established that AIWS is a disorder of perception rather than a psychiatric hallucination.

What are the symptoms?

Episodes of AIWS are usually brief, lasting from a few minutes to around half an hour. During an episode, objects may appear smaller or larger than they actually are, or they may seem much closer or farther away than reality. Some individuals report that parts of their own body, such as their hands or head, feel as if they are shrinking or expanding. Others experience distortions in the perception of time, feeling as though time is moving extremely fast or very slowly. These symptoms have been documented in observational studies published in Frontiers in Neurology. Although unsettling, these episodes are generally harmless and transient.

What causes AIWS?

AIWS is not a disease in itself but a symptom triggered by underlying conditions. In children, infections are the most frequent cause. Studies in Pediatric Neurology identify the Epstein-Barr Virus, which causes mononucleosis, as the most common infectious trigger. Other infections, such as influenza, varicella, and Lyme disease, have also been linked to the syndrome. 

In adults, AIWS is most frequently associated with migraines, often appearing as part of a migraine aura and sometimes occurring without headache, a pattern described in The Lancet. Less common causes include temporal lobe epilepsy, medications containing dextromethorphan, and structural brain lesions. Research published in the Journal of Neurology, Neurosurgery & Psychiatry notes that disruptions in the temporo-parietal-occipital junction, a region integrating visual, spatial, and sensory information, can cause the characteristic perceptual distortions.

Who is at risk of AIWS?

AIWS can affect individuals at any age, but it is most common in children recovering from viral infections. Most childhood cases resolve naturally over time, as reported in Pediatric Neurology. Adults with a history of migraine aura are also at higher risk. A smaller subset of patients may experience AIWS due to epilepsy or other neurological conditions, according to Frontiers in Neurology. While generally transient, recurrent episodes in adults can cause discomfort and distress, although they are not considered dangerous.

How is AIWS diagnosed?

There is no definitive test for AIWS. Diagnosis relies on a careful review of symptoms, medical history, and potential triggers. Neurological examinations are often conducted, and imaging such as MRI or CT scans may be used to rule out structural abnormalities. EEG testing may be performed if epilepsy is suspected, and blood tests in children can help identify infections such as Epstein-Barr Virus. The Journal of Neurology, Neurosurgery & Psychiatry says that while most diagnostic tests appear normal, they are important for ruling out other conditions rather than confirming AIWS directly.

What is the prognosis for AIWS?

The prognosis for AIWS is generally positive. Most children recover completely, particularly when the syndrome is linked to viral infections. Adults may experience recurrent episodes associated with migraines, but these episodes are typically manageable and not harmful. An article in the journal Neurology Clinical Practice notes that long-term complications are rare and that the overall outcome depends largely on addressing the underlying cause.

How is AIWS treated?

There is no specific treatment for AIWS itself. Management focuses on treating the underlying cause. Infection-related AIWS in children often resolves as the illness clears. In adults, migraine-related AIWS may be managed with preventive medications and lifestyle adjustments, including regular sleep, hydration, and stress management. Cases related to epilepsy or brain lesions require targeted interventions such as anti-seizure medication or surgical treatment. When medications trigger AIWS-like symptoms, adjusting or discontinuing the drug usually leads to improvement. Reassurance is a key component of care, particularly for children, as the episodes can be disorienting despite being medically benign, as noted in The Lancet and Neurology Clinical Practice.