What Is Alice in Wonderland Syndrome

Introduction 

In the tale “Alice in Wonderland”, Alice observed objects take on various unique shapes. The size of some things shrank while that of others grew. 

After learning about these symptoms, a British psychiatrist, Dr John Todd, chose the name “Alice in Wonderland syndrome” for a mental health condition. 

Todd’s syndrome is another name for the disease. These perplexing consequences indicate an uncommon neurological disorder. 

This condition can cause severe headaches as well as epilepsy. People may become paralysed for hours or days at a time from the symptoms, which can be crippling. Each individual is impacted by this syndrome differently. Some people rarely experience the symptoms, while others have the symptoms repeatedly.

What is AWS? 

Todd’s syndrome, commonly referred to as Alice in Wonderland syndrome, is a rare disorder. It was originally reported in the 1950s and is characterised by brief periods of a false sense of body size. 

Similar to what the well-known character Alice experiences in the story, those with Alice in Wonderland syndrome experience these episodes when they feel as though their body is either larger or smaller than normal and that objects and people around them appear larger or smaller than usual. 

Though the experience is highly intense, the person knows that what they are seeing and experiencing is not real. The experiences of Alice in Wonderland syndrome are not hallucinations. The frequency and timing of these episodes are unpredictable, and the episodes themselves are frequently brief.

According to a study, 17 of the 81 individuals who had this syndrome at the time of the analysis had provided information about the length of their episodes. Nine of these participants had episodes that lasted under five minutes, while seven had episodes that lasted between five and thirty minutes. A member of this group experienced a two-day-long episode.

Alice in Wonderland syndrome can affect people of all ages, and up to one-third of patients still experience continuous episodes. These episodes tend to occur most frequently in children and young adults.

Episodes can result from several medical disorders, the most common of which is an infection, and the source of the sickness is frequently unknown. 

The causes of migraine in people with Alice in Wonderland syndrome are noted in 6–11% of instances, and this syndrome is also closely linked to epilepsy.

What are the causes of AWS? 

The cause of Alice in Wonderland is unknown. The following are only a few of the potential causes.

• Migraine – A migraine aura is one of the most frequent causes of AWS. It may also occur with other types of headaches, including stomach migraines and cluster headaches.

• Certain stroke types – Brain regions that regulate self-perception and visual perception can be affected by a sudden drop in blood flow.

• Seizures – Individuals with seizure-related illnesses, particularly epilepsy, can develop AWS.

• Infections – One of the most frequent causes of AIWS is bacterial and viral infections. It can be brought on by many diseases, including Epstein-Barr virus (EBV), type A or H1N1 influenza, varicella (which causes chickenpox and shingles), typhoid fever, Lyme disease and scarlet fever. 

• Brain tumours, including cancers.

• Mental health conditions – They include depressive illnesses, schizoaffective disorder, and schizophrenia, among others.

• Medications – Several medications may have AIWS as a side effect. They comprise substances found in common cough medicines like dextromethorphan or dihydrocodeine, asthma medications like montelukast and anti-seizure medications like topiramate.

• Inhalants and recreational drugs – LSD and toluene are examples of hallucinogens and inhalants, respectively.

• Degenerative brain diseases – There have been cases of AIWS occurring in patients with diseases like Creutzfeldt-Jakob disease. The occurrence is rare.

Symptoms of AWS 

Each person experiences AWS in a unique way. The average episode is a few minutes long. Some can last up to 30 minutes.

One might go through one or more of the typical symptoms listed below during the episodes.

Migraine

Migraines are more common in those who have AWS. AWS is thought to be an aura by some scientists and medical professionals. This is a warning sign of a migraine in its early stages. Others think AWS might be an unusual form of migraine.

Perceptual distortion

The patient has pelopsia if they sense that things that are close are getting bigger or closer than they are. Teleopsia is the exact opposite of that. It’s the perception that things are getting closer to the patient or smaller than they are.

Sound distortion

Every sound, even those that are usually faint, appears intrusive and loud.

Distorted body image

Micropsia is the perception that the surroundings or a person’s body is getting smaller. Macropsia is the perception that the body or the things around the patient is expanding. Both of these frequently occur during an AWS episode.

Distortion of time

Some AWS patients lose a sense of their time. They can believe that time is passing more quickly or slowly than it is.

Loss of coordination or limb control

When muscles feel as though they are responding unintentionally, this symptom occurs. In other words, the patient can experience a lack of control over their limbs.

Similarly, the altered perception of reality might impact how a person moves or walks. One might experience a lack of coordination.

Diagnosis of AWS 

Anyone who encounters these signs and symptoms ought to consult their doctor. To prevent it from getting worse over time, doctors should keep an eye on it each time it occurs. 

Patients will likely be sent to a neurologist. However, there isn’t only one test available to diagnose people with AIWS. This means that before deciding on Todd’s syndrome, the doctor will order several tests and rule out other potential medical disorders.

Before ordering any tests, the doctor will enquire about the patient’s symptoms and prior migraine experiences. These are a few of the tests.

• Electroencephalography (EEG): A brain’s electrical activity can be measured using an EEG.

• Blood tests can confirm viruses like the Epstein-Barr virus and help rule out other medical disorders.

• MRI scan – An MRI produces detailed pictures of the brain. This will aid in detecting or excluding any brain tumours.

For a correct diagnosis, persistence is important. To keep track of symptoms, doctors should document every visit in detail.

Treating AWS 

There is no known cure for Alice in Wonderland Syndrome. The best course of action for this disease is to support the patient to feel more comfortable.

The best treatment for Alice in Wonderland Syndrome symptoms may depend on the root cause. If migraines are the cause, treating them themselves may be the best course of action.

The most popular method of treatment involves migraine prevention followed by a migraine diet, but this fix may or may not work for everyone. Most of the time, AWS subsides with age and primarily affects children.

Complications

With time, AWS symptoms usually get better. Problems or consequences related to the disease are rare.

Although migraines do not always cause this disease, a patient with AWS is likely to get migraines.

Even though they are not hazardous, the Symptoms of Todd’s Syndrome can be confusing. But, in other circumstances, these symptoms might point to a more severe issue.

Individuals may experience the syndrome numerous times per day for several days in a row, with the occasional disappearance of symptoms for several days or even weeks.

Although rest and dietary adjustments are advised, there is no established treatment for AWS. The syndrome typically self-terminates and disappears when adulthood sets in.

When to see a doctor?

If the patient has never had symptoms of AIWS before, they should seek emergency medical attention. This is due to the fact that AIWS itself may be a sign of severe or even fatal medical issues. 

The healthcare practitioner informs the patient of the symptoms or warning signs that indicate they need urgent medical attention if they have a history of AIWS and a chronic illness that has been diagnosed as being able to trigger it.

Conclusion 

Alice in Wonderland Syndrome (AIWS) refers to a group of symptoms that include changes in one’s body image. The wrong size of body parts or the wrong size of external objects is sensed due to a change in visual perception. 

Most perceptions occur at night. It is still unknown precisely what causes AIWS. Common migraines, epilepsy of the temporal lobe, brain tumours, psychotropic medicines, or Epstein-Barr virus infections can bring on AIWS. 

No clear, effective treatment exists for AIWS. The migraine diet and prophylaxis are the main components of the treatment plan. 

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