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Alice in Wonderland Syndrome (AIWS) is a neurological disorder that distorts perception, causing affected individuals to see objects, body parts, or even time as being drastically altered in size, shape, or speed. Named after the famous scenes in Lewis Carroll’s Alice’s Adventures in Wonderland, where Alice experiences similar distortions, this syndrome is most commonly associated with migraines and other neurological conditions. This article provides an overview of AIWS, its symptoms, potential causes, and management options.

Keywords: Alice in Wonderland Syndrome, AIWS symptoms and causes, Micropsia and macropsia, Visual distortions in AIWS, Perceptual distortions

AIWS is characterised by a range of perceptual distortions, including:

• Micropsia and Macropsia: Objects appear smaller (micropsia) or larger (macropsia) than they actually are, impacting depth perception and spatial awareness.
• Body Dysmorphia: Individuals may perceive parts of their body as being altered in size, often feeling as though limbs or the head are disproportionate.
• Time Distortion: The passage of time may feel sped up or slowed down, creating a sense of disorientation (Blom 2016).

These symptoms can vary in intensity and duration, often appearing in episodic “attacks” that last minutes to hours. AIWS is often seen in children, but it can also affect adults and may be accompanied by other neurological symptoms.

While the exact cause of AIWS is unknown, several theories point to neurological and physiological factors that contribute to its symptoms:

1. Migraines
AIWS is frequently linked to migraines, with many individuals experiencing perceptual distortions as part of their aura (the sensory symptoms that precede a migraine). Brain imaging studies suggest that certain types of migraine affect regions of the brain responsible for visual processing and spatial awareness, leading to the hallmark symptoms of AIWS (Kumar et al. 2013).

2. Epilepsy
Some individuals with epilepsy also report symptoms of AIWS. The disorder’s visual and spatial distortions are thought to arise from abnormal electrical activity in brain regions such as the occipital and parietal lobes, which are involved in visual and spatial processing.

3. Viral Infections
Certain viral infections, particularly Epstein-Barr virus (EBV), have been associated with AIWS. Cases have been reported where children develop AIWS symptoms following an infection. Researchers theorise that the infection or resulting inflammation may disrupt normal brain function, triggering perceptual distortions (Blom 2016).

Although the visual and sensory distortions caused by AIWS are typically harmless, they can be unsettling and disruptive:

• Confusion and Disorientation: The altered perceptions can lead to confusion, especially for young children who may struggle to articulate what they are experiencing.
• Anxiety and Fear: The sudden onset of intense perceptual changes can trigger anxiety, particularly in individuals who do not understand why they are experiencing these distortions.
• Social Challenges: Children and adolescents may feel isolated if they are unable to communicate their experiences to others or if their symptoms are dismissed as “imagination.”

Most episodes of AIWS are short-lived and have no lasting impact on mental health, though frequent episodes may contribute to anxiety in some individuals.

Diagnosing AIWS can be challenging, as the symptoms are highly subjective and can mimic other neurological conditions. Neurologists often rely on detailed patient histories, symptom descriptions, and neurological examinations to differentiate AIWS from other disorders.

1. Managing Underlying Conditions
Since AIWS often occurs in conjunction with migraines, epilepsy, or viral infections, treating the underlying condition can reduce or eliminate episodes. For example, managing migraines with medications, lifestyle changes, and avoiding known triggers may alleviate AIWS symptoms in some individuals.

2. Supportive Care and Education
For those who experience occasional episodes, reassurance and education can help reduce the anxiety associated with the syndrome. Explaining that AIWS is a benign condition can provide comfort, particularly for children who may feel frightened by their experiences.

3. Cognitive-Behavioural Therapy (CBT)
CBT can be helpful for individuals who develop anxiety or fear as a result of AIWS. Therapy can help them learn strategies to manage their reactions to symptoms and reduce the impact on daily life.

Alice in Wonderland Syndrome is a rare and unusual neurological disorder that distorts perception, affecting how individuals see objects, time, and their own bodies. While often associated with migraines, epilepsy, or viral infections, AIWS remains under-researched and poorly understood. Increased awareness of this syndrome can help healthcare providers support patients experiencing these surreal symptoms, reassuring them that, despite the disorienting effects, AIWS is generally a benign condition.

• Blom, JD 2016, A Dictionary of Hallucinations, Springer, New York.
• Kumar, P, Deb, S & Basu, D 2013, ‘Alice in Wonderland syndrome: Hallucinations due to focal epilepsy’, Pediatric Neurology, vol. 48, no. 1, pp. 77-78.

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