Alice in Wonderland Syndrome

Article By: Lee Ann Swenson, American Medical Writers Association member

Understanding Alice in Wonderland Syndrome
Alice in Wonderland syndrome, also known as Todd’s syndrome, is a rare condition of temporary episodes of distorted perception of body size that was first described in the 1950s. During these episodes, those with Alice in Wonderland syndrome feel that their body is either larger or smaller than normal, and/or objects and people around them appear larger or smaller than usual — much like the well-known character Alice experiences in Carroll’s stories. In fact, Carroll himself suffered from migraines, and it has been suggested that some of his own experiences may have been inspiration for his writing. 1 2

Episodes of Alice in Wonderland syndrome are not hallucinations; and although the experience is quite vivid, the individual recognizes that what they are seeing and feeling is not real. 3 When and how often these episodes happen is unpredictable, and the episodes themselves are usually relatively short.

For example, in one recent analysis of 81 people who experienced this syndrome, 17 had reported the duration of their episodes. Nine of these participants had episodes lasting less than five minutes, and seven experienced episodes lasting from five to 30 minutes. However, one person in this group had an episode that lasted for two days. 4

Although these episodes happen most often in children and young adults (and, for some, eventually stop occurring over time), Alice in Wonderland syndrome can affect individuals of all ages, and as many as one-third of sufferers continue to experience ongoing episodes.

In many cases, the cause of the syndrome is not defined, and episodes can arise from several different medical conditions, most commonly an infection. This syndrome is also closely associated with epilepsy and migraine — among individuals with Alice in Wonderland syndrome, migraine is cited as the cause in 6 to 11 percent of cases.

Alice in Wonderland Syndrome and Migraine:
Because the syndrome is so rare, the links between it and migraine are not yet fully known. But the episodes can occur during a headache or migraine, and some consider the visual disturbances to be an aura that comes before a migraine. 5

It has also been suggested that the syndrome itself could be a rare “migraine variant” or “migraine equivalent” — in other words, a migraine that appears in a different form than a more common migraine headache. 6 In these situations, the visual episodes may occur without any headache pain at all.

Those who experience Alice in Wonderland syndrome often have family members who suffer from migraines; they may also develop migraines later in life. For example, in one study of 48 people who experienced these episodes, one third later developed migraines, even though they had no history of these headaches. 7

Now you’ve got the basics on this rare but fascinating condition. If you think that you or a family member have had these feelings or perceptions, be sure to talk to your doctor.

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