What is Alice in Wonderland syndrome?

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Last updated: April 23, 2025 • View editorial policy

From the Research

Alice in Wonderland Syndrome (AIWS) is a rare neurological disorder that should be managed by addressing the underlying cause, with treatment focusing on the specific trigger, such as migraines, epilepsy, or infections, rather than the syndrome itself 1, 2, 3, 4, 5.

Definition and Characteristics

AIWS is characterized by distorted perception, particularly of body image and spatial relationships, with people experiencing episodes where they perceive objects or body parts as larger (macropsia) or smaller (micropsia) than they actually are, similar to the experiences described in Lewis Carroll's "Alice's Adventures in Wonderland" 1.

Causes and Triggers

Common triggers include migraines, epilepsy, infections (particularly Epstein-Barr virus), brain tumors, psychoactive drugs, and psychological stress 2, 3, 4, 5.

  • Migraines are a common cause in adults, while encephalitis is more common in children and adolescents.
  • Infections, such as Epstein-Barr virus, can also trigger AIWS symptoms.
  • Other causes include brain tumors, psychoactive drugs, and psychological stress.

Treatment and Management

Treatment for AIWS focuses primarily on addressing the underlying cause rather than the syndrome itself 2, 3, 4, 5.

  • For migraine-related AIWS, medications like topiramate, valproic acid, or propranolol may be prescribed as preventatives, typically starting at low doses and gradually increasing as needed.
  • If epilepsy is the cause, anticonvulsants such as levetiracetam or carbamazepine might be used.
  • When infections trigger symptoms, treating the underlying infection often resolves the perceptual distortions.

Patient Care and Monitoring

Patients should maintain a symptom diary to identify potential triggers and should seek immediate medical attention if symptoms worsen or are accompanied by severe headache, confusion, or loss of consciousness 2, 3, 4, 5.

  • The syndrome often resolves on its own, particularly in children, but understanding the neurological basis—believed to involve the visual pathways and temporal-parietal areas of the brain—can help manage the sometimes frightening symptoms.
  • Reassurance that the symptoms themselves are not harmful seems to suffice in about 50% of the cases, particularly when the underlying cause is not severe or life-threatening.

References

Research

The Alice-in-Wonderland Syndrome.

Frontiers of neurology and neuroscience, 2018

Research

Alice in Wonderland syndrome: A systematic review.

Neurology. Clinical practice, 2016

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.