Alice in Wonderland Syndrome (AIWS), also known as Todd’s syndrome or Liliputian hallucinations, is a rare neurological disorder where objects appear larger or smaller than they actually are. In a review conducted by Osman Farooq and Edward J. Fine, they state that the reason the syndrome is named after Lewis Carroll’s book “Alice’s Adventures in Wonderland” is because the protagonist, Alice, had experienced “alterations of sensation in which she felt that her body had grown too tall or too small, or parts of her body were changing shape, size, or relationship to the rest of her body”. This describes the condition well as it is a disorienting neurological condition that affects vision, hearing, touch, sensation, and even the perception of time. According to the review, people with Alice in Wonderland syndrome can experience changes in the size of objects or their own body parts, a phenomenon known as metamorphopsias.
According to the University of Pittsburgh Medical Center (UPMC), AIWS has multiple symptoms, neither of which occur simultaneously. These are micropsia (objects appear smaller than normal), teleopsia (objects appear further away than they actually are), macropsia (where objects appear larger than normal), metamorphopsia (where straight lines appear wavy or warped), and pelopsia (where objects appear closer than they actually are).
Since there is limited research done on this condition, it’s unclear what other symptoms are directly involved with AIWS. However, symptoms like hallucinations and seizures are believed by some to be related directly with the conditions that triggered the cause of AIWS. There are several direct causes of AIWS, according to UPMC, such as head trauma, migraines, infection, and brain tumors.
Although most common in children, AIWS can occur at almost any age, and among the above direct causes, the condition has a strong link with migraines as there has been many cases of it cooccurring with AIWS. In a review of 166 published AIWS cases, the most common causes of AIWS was migraine, with 27%.
The limited research done on AIWS could partly explain the rarity of the condition. According to the Cleveland Clinic, some research shows that up to 30% of teenagers experience “brief episodes” of AIWS, but more research is needed to determine if this is actually true. AIWS is almost always temporary, which can also explain why there is so little research done on the condition – the condition is so rare that cases rarely become serious enough to warrant medical attention.
Reinforcing what’s little known about this condition is the fact that it is probably, as stated in a 2016 review, a misdiagnosed syndrome, since there is not yet a definite diagnostic criteria made for it. Many diagnoses of AIWS mainly depends on the physician’s professional judgement. The little research further reinforces the fact that there is little confirmed about the condition’s prevalence.
The symptoms of AIWS could lead one to feel panic-stricken or anxious, as someone with the condition would experience distortions or hallucinations multiple times during the day. This disruption in the brain’s ability to perceive senses will affect how a person sees their surroundings or how they perceive their own body.
As there is no direct treatment yet for Alice in Wonderland Syndrome, the main focus is to give supportive care by making the patient more comfortable. There is also a focus on treating the direct causes of the condition, especially migraines, as they have shown to likely play a role in its occurrence.
The most common attempt at treating AIWS would be through diet and preventive medicine, in the case of migraines being the direct cause. If a condition like epilepsy is the cause, doctors might prescribe anti-epileptics. If there is an infection, doctors might prescribe antivirals or antibiotics, depending on the kind of infection. In a review conducted by Professor Jan Dirk Blom of Leiden University, antipsychotics are rarely prescribed because their use won’t show much improvement, and there is a likelihood that it could instead cause aggravation of epileptic activity and exacerbate the overall patient condition.
In essence, Alice in Wonderland Syndrome is still very much an enigmatic condition shrouded with mystery with the little research that has been done to show for. There is still much to discover about AIWS, and further research is needed to establish conclusive links between the condition itself and the direct causes connected to it, such as migraines, epilepsy, infections, and more. AIWS is a fascinating neurological condition that plunges people into a world of surreal and disorderly experiences and serves as a reminder of the complexity and marvels of the brain, and the many underlying mechanisms we still have yet to learn about.