What is it?

Alice in Wonderland syndrome is a neuropsychological condition that causes a distortion of perception. People may experience distortions in visual perception of objects, such as appearing smaller (micropsia) or larger (macropsia), or appearing to be closer (pelopsia) or farther (teleopsia) than they actually are. Distortion may also occur for senses other than vision.

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Additional names

This group contains additional names:
- Todd's syndrome
- Dysmetropsia
- Tachysensia

Signs & symptoms

Alice in Wonderland syndrome affects the sense of vision, sensation, touch, and hearing, as well as the perception of one's own body image. Migraines, nausea, dizziness, and agitation are also commonly associated symptoms with Alice in Wonderland syndrome. Less frequent symptoms also include loss of limb control and coordination, memory loss, lingering touch and sound sensations, and emotional instability. Alice in Wonderland syndrome is often associated with distortion of sensory perception, which involves visual, somatosensory, and non-visual symptoms. Alice in Wonderland syndrome is characterized by the individual being able to recognize the distortion in the perception of their own body and is episodic in nature. Alice in Wonderland syndrome episodes vary in length from person to person. Episodes typically last from a few minutes to an hour, and each episode may vary in experience.

Diagnosis

Since there are no established diagnostic criteria for Alice in Wonderland syndrome, and because Alice in Wonderland syndrome is a disturbance of perception rather than a specific physiological condition, there is likely to be a large degree of variability in the diagnostic process and thus it can be poorly diagnosed.Often, the diagnosis can be presumed when other causes have been ruled out. Additionally, Alice in Wonderland syndrome can be presumed if the patient presents symptoms along with migraines and complains of onset during the day (although it can also occur at night). Ideally a definite diagnosis requires thorough physical examination, proper history taking of episodes and occurrences, and a concrete understanding of the signs and symptoms of Alice in Wonderland syndrome for differential diagnosis. A person experiencing Alice in Wonderland syndrome may be reluctant to describe their symptoms out of fear of being labeled with a psychiatric disorder, which can contribute to the difficulty in diagnosing Alice in Wonderland syndrome. In addition, younger individuals may struggle to describe their unusual symptoms, and thus, one recommended approach is to encourage children to draw their visual illusions during episodes. Cases that are suspected should warrant tests and exams such as blood tests, ECG, brain MRI and other antibody tests for viral antibody detection. Differential diagnosis requires three levels of conceptualization. Symptoms need to be distinguished from other disorders that involve hallucinations and illusions. It is usually easy to rule out psychosis as those with Alice in Wonderland syndrome are typically aware that their hallucinations and distorted perceptions are not 'real'. Once these symptoms are distinguished and identified, the most likely cause needs to be established. Finally, the diagnosed condition needs to be evaluated to see if the condition is responsible for the symptoms that the individual is presenting. Given the wide variety of metamorphopsias and other distortions, it is not uncommon for Alice in Wonderland syndrome to be misdiagnosed or confused with other etiologies.

Treatment

At present, Alice in Wonderland Syndrome has no standardized treatment plan. Since symptoms of Alice in Wonderland syndrome often disappear, either spontaneously on their own, or with treatment of the underlying disease, most clinical and non-clinical Alice in Wonderland Syndrome cases are considered to be benign. In cases of Alice in Wonderland syndrome caused by underlying chronic disease, however, symptoms tend to reappear during the active phase of the underlying cause (e.g., migraine, epilepsy). If treatment of Alice in Wonderland Syndrome is determined necessary and useful, it should be focused on treating the suspected underlying disease. Treatment of these underlying conditions mostly involves prescription medications such as antiepileptics, migraine prophylaxis, antivirals, or antibiotics. Antipsychotics are rarely used in treating Alice in Wonderland Syndrome symptoms due to their minimal effectiveness

☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.

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