Alice in Wonderland syndrome (AWS): Treatment, Cause & Symptoms 

Hey guys! Today we are going to see about Alice in Wonderland syndrome (AWS) You can know more about the symptoms, treatment, causes & types based on proved case studies about Alice in Wonderland syndrome (AWS).

What is Alice in Wonderland syndrome (AWS)?

It is a rare condition also known as Todd’s syndrome causing temporary episodes of distorted perception and disorientation. You may feel larger /smaller than you actually are, along with the feeling that the room you’re in or the surrounding furniture seems to shift and feel further away or nearer than it really is.

Reason behind the name?

The reason behind the names Alice in Wonderland syndrome (AWS)/Todd’s syndrome is because it was first identified in the 1950s by Dr. John Todd, a British psychiatrist. When he noted the symptoms he recognized that it resembled episodes that the character Alice Liddell experienced in Lewis Carroll’s novel “Alice’s Adventures in Wonderland.”

‘AWS mainly affects children and young adults.’

These episodes aren’t caused by a problem with a person’s eyes or a hallucination. They’re caused by changes in how brain perceives the environment you’re in and how body looks. This syndrome affects multiple senses including vision, touch, and hearing. The person suffering with this may also lose a sense of time. Time may seem to pass faster or slower than they think. Many grow out the disordered perceptions as they age but it’s still possible to go through this in adulthood.
AIWS affects the way a person perceives:

  1. Sight
  2. Hearing
  3. Touch
  4. Sensation
  5. Time

Micropsia are the most common visual distortions which a person sees objects as smaller than they are, and teleopsia, where objects appear farther away than they are in reality.
There are three main categories of AIWS, which differ according to the type of perceptual disorder. They are:
1.Type A, where disorders are somesthetic, or sensory
The authors in a 2016 year article state that type A follows the original definition of AIWS, which involves people feeling as though their body parts are changing size.
2.Type B, which affects visual senses
Type B causes more visual distortions of the surrounding environment.

  1. A person with Type B AIWS may experience:
  2. micropsia, where objects appear too small
  3. metamorphopsia, where aspects of shapes, such as height and width, appear inaccurate
  4. pelopsia, where objects appear too close
  5. teleopsia, where objects appear farther away than they are

3.Type C, which is a mix of types A and B
Type C AIWS makes a person perceive both the image of their own body and that of other people or things around them to be changing.

“According to a 2012 study, there are more cases of Type B in young individuals and more cases of Type C in adults.”

Symptoms of Alice in Wonderland syndrome (AWS):

The symptoms of AIWS depend on its type and the person it affects.
They may include:

  1. distorted body image
  2. altered perception of time
  3. Metamorphopsia
  4. distorted perception of size
  5. Symptoms that accompany an episode may include:
  6. feverish symptoms
  7. migraine episodes
  8. epileptic seizures that affect only part of the brain

Causes of Alice in Wonderland syndrome (AWS):

It’s not clearly known what causes AWS but doctors are trying to understand it better. It is confirmed that AWS isn’t a problem with eyes, a hallucination, or a mental or neurological illness. Researchers believe unnatural electrical activity in the brain causes abnormal blood flow to the parts of the brain that process your environment and experience visual perception. This might be the caused due of several causes.

A study concluded that 33 percent of people who experienced AWS had infections. Both head trauma and migraines were the reason connecting 6 percent of AWS episodes. More than half of AWS cases had no known cause. Even though more research is needed on Alice in Wonderland syndrome, migraine is the leading cause for AWS in adults. Infection is considered the primary cause for AWS in children.
Other possible causes are:

  1. Stress
  2. cough medicine
  3. use of hallucinogenic drugs
  4. Epilepsy (group of neurological disorders – causes recurrent epileptic seizures)
  5. Stroke
  6. brain tumor

Associated conditions or other risk factors:

Several conditions are linked to AWS. The following may increase the risk for it:
  1. Migraines- AWS may be a sensory warning of a coming migraine. Some doctors believe AWS may be a subtype of migraines.
  2. Infections- AWS episodes may be an early symptom of the Epstein-Bar virus (EBV). This virus can cause infectious mononucleosis.
  3. Genetics- Ones with a family history of migraines and AWS are at a higher risk for experiencing this rare condition.

Can AWS lead to complications?

AWS often gets better over time but causes complications or problems once in a while. Although this syndrome isn’t predictive of migraines, you’re more likely to develop them if you have these episodes. According to a study, a third of people without a history of migraine headaches developed them after experiencing AWS.

Treatment and management:

The course of treatment for AIWS is based on the underlying cause. If migraine is the source of the condition, doctors suggest managing migraine through diet and preventive medicines . If epilepsy is causing the symptoms, a doctor may prescribe antiepileptics (antiseizure drugs). If an infection is responsible, they may offer antiviral agents.
Doctors rarely prescribe antipsychotics (used to manage delusions, hallucinations, etc..) because, despite the nature of the syndrome, there is no psychosis in AIWS. Antipsychotics can also increase the chances of epileptic activity, possibly making a person’s condition worse.


No formal established criteria for diagnosing AIWS as the range of potential symptoms is broad. When diagnosing AIWS, the doctor reviews the symptoms that the person is experiencing in a manner that helps them feel comfortable. The doctor can then look for the causes of each symptom and assess how they link together.
Tests for diagnosing AIWS may include:

  1. neurological and psychiatric consultation to assess mental status
  2. routine blood testing
  3. MRI scans to provide an image of the brain
  4. electroencephalography (EEG), which tests electrical activity in the brain and can help doctors identify epilepsy
  5. additional assessments

When to see a doctor?

A person should seek medical attention if they are experiencing any of the symptoms above, even if episodes are short. A doctor may find an underlying cause that was not previously clear. Identifying a cause will make it easier to reduce the severity of the symptoms.


Alice in Wonderland syndrome is a very rare disorder that causes distorted perception. The syndrome mostly affects children but can begin at any point in life. Treatment is not directly available but depends on diagnosing and treating underlying causes. Researchers do not yet understand many aspects of the syndrome, more studies are required before they can determine whether an effective, direct treatment is possible. Make note of the causes and if you or anyone you know ever have an episode get treated for this ASAP! We hope you learned more about Alice in wonderland syndrome.

Author: Hi there, my name is Subin Joshua, and I am a Medical student. I grew up in a family of teachers and know that being a social worker is my calling. My passion for helping others has been evident in my involvement in helping the poor and needy for the last three years. Through those experiences, I have learned to interact with a diverse group of people, which has increased my ability to relate to others.

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