Alice in Wonderland Syndrome

What is Alice in Wonderland Syndrome?

Alice in Wonderland Syndrome (AWS) is a rare neurological disorder which leads to temporary periods of perceptual disturbances and disorientation. A person may feel bigger or smaller in size than they really are. Individuals suffering from Alice in Wonderland Syndrome might be under an impression that the surroundings of a person are expanding or diminishing more than the person themselves. Other interpretations contain distortions of visual perception, including the sense that a specific environment is shifting. It’s an unusual disorder that momentarily affects how objects are perceived by the brain.

Alice in Wonderland Syndrome (AIWS) is also known as Todd’s Syndrome, after the English psychiatrist called John Todd who gave name to the disorder in 1955.

The name of the syndrome comes from the book, Alice’s Adventures in Wonderland written by Lewis Carroll, in which the central character, Alice, comes across similar situations to ones that are experienced in this condition.


What are the causes? 

The exact cause of Alice in Wonderland Syndrome is not known. It is known that AWS isn’t a problem with one’s eyes, a hallucination, or a psychological or neural illness. Approximately 166 cases of AIWS have been reported in the literature, describing different forms of disorders associated with the syndrome. Migraines (27.1 percent) are the most prevalent, accompanied by infections (22.9 percent), primarily associated with the Epstein–Barr virus (15.7 percent). In comparison, brain damage, medications, psychotropic agents, mental illnesses, and seizures arise in diminishing order of occurrence.

Findings indicate that irregular electrical stimulation in the brain triggers unusual blood supply to areas of the brain that perceive the surroundings and experience sensory perception. This irregular electrical behavior can be the due to a variety of factors.

Another research showed that 33% of people with AWS had infections. Both brain injuries and migraine were related to 6% of the AWS episodes. But more than half of the AWS cases did not have a known source.

While further research is necessary, migraine is known to be the leading cause of AWS in adults. Infection is known to be the main cause of AWS in infants.

AWS can be caused due to other infectious diseases like:

  • mycoplasma
  • influenza A virus
  • varicella-zoster virus
  • typhoid encephalopathy
  • Lyme neuroborreliosis

Some other causes may include:

  • stress
  • brain lesions
  • medication
  • psychiatric conditions
  • epilepsy
  • stroke
  • cough medicine
  • use of hallucinogenic drugs

What are the symptoms?

AWS manifests differently in different people. The episodes for the same person may also vary from one to next. The symptoms may last for thirty minutes. Some common symptoms experienced are-


Individuals who develop AWS are often more likely to experience migraine. It is believed by researchers and doctors assume that AWS is essentially an aura. Some believe it is an early sensory sign for a migraine whereas others assume the AWS may be a rare subgroup of migraine.

Size Distortion

A sensation that the body or the things surrounding you are diminishing is known as micropsia whereas macropsia is a sense that the body or the things surrounding you are becoming bigger. Both the experiences are common symptoms of AWS.

Perceptional Distortion

If you believe like things around you are becoming larger or getting nearer to you than they actually are, you’re sensing pelopsia. Teleopsia is the reverse. It’s the impression that the items are shrinking or getting further away from you than they actually are.

Time Distortion

Some individuals with AWS lack the perception of time. They often believe that time is going too quickly or slowly than it actually is.

Sound Distortion

Various kinds of sound, including the normal silent tones, seems noisy and disturbing to those suffering from AWS.

Lack of control over limbs or loss of coordination

This sign tends to occur when muscles feel as if they function involuntarily. In other words, you can feel like you’re not managing your limbs. Likewise, the distorted sense of reality can have an impact as to how you move or walk. You may feel clumsy or have trouble walking around as you normally would.

Diagnosis of AWS

There isn’t a particular test or tool for the diagnosis of AWS. The doctor can try to link the different causes of each symptom and assess the associations between them. They may also use the following tests for diagnosing AWS-

  • MRI Scan– This will produce a detailed and overall picture of the brain and other organs.
  • Electroencephalography- The EEG measures electrical functionalities of the brain.
  • Blood tests– Doctors can check the presence or absence of viruses or infections, e.g. EBV, causing the symptoms of AWS.
  • Neurological and Psychiatric Consultation- May be helpful in assessing the mental status of the individual.



The underlying cause and symptoms of AWS experienced define the necessary course of treatment. If migraine is the cause of the disorder, physicians can recommend migraine treatment through nutrition and preventive medicine whereas if epilepsy triggers symptoms, the doctor can recommend antiepileptic drugs. They can provide antiviral agents if the infection is responsible for the disorder.

According to a comprehensive study in 2016, clinicians hardly recommend antipsychotics because, despite the severity of the condition, there is no psychosis associated with AIWS.

Antipsychotics can also enhance the odds of epileptic disorder, which can worsen the symptoms of the person.


Alice in Wonderland syndrome: Definition, symptoms, and treatment (

Alice in Wonderland Syndrome | Neurology Live

Alice in Wonderland Syndrome: Symptoms, Treatment, and More (

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Written by Aastha Kothari

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