Considered somewhat rare, the condition is more common than people think

By Osman Farooq, MD and Edward J Fine, MD

Alice in Wonderland Syndrome (AIWS) is a neurological condition that affects our perception to the senses of vision, hearing, touch, sensation, and the phenomenon of time. The name refers to Lewis Carroll’s well-known children’s book Alice’s Adventures in Wonderland, in which the title character experiences alterations of sensation feeling that her body had grown too tall or too small, or that parts of her body were changing shape, size, or relationship to the rest of her body.  

People with AIWS can experience alterations in perception, including micropsia (objects appear small), macropsia (objects appear large), teleopsia (objects appear further away than they are), and pelopsia (objects appear closer than they are). They can also experience sensations in feeling that their own body or body parts are rapidly shrinking, or growing inexplicably taller or larger. Similarly, depth perception can be altered, where distances appear incorrect. For example, a corridor may appear very long, or the ground may appear too close or distant

Individuals with AIWS can also lose the sense of time, feeling that time passes very slowly or quickly. This lack of time and space perspective leads to a distorted sense of velocity. For example, normal movements may appear as if things are moving in slow motion. Conversely, other movements may appear as if the motion is incredibly fast. Individuals with AIWS can also experience changes in sound, causing soft sounds to appear amplified, or muffled, as if hearing under water. The misperceptions can also involve seeing animals or insects, such as spiders or ants that aren’t there. 

AIWS can occur at any age, but is often more common in childhood and adolescence. It can be seen in a variety of disorders, including headache/migraine, epilepsy, or after taking intoxicants such as LSD or peyote, infectious states, and other types of brain lesions. When AIWS occurs in children, it often occurs during illnesses or fevers, such as the flu or common cold.  

There is no specific treatment for AIWS. Managing it involves treating the underlying condition, such as migraines, epilepsy, etc. People with AIWS can frequently be very troubled by what they experience, which can cause them to be hesitant to express their symptoms. Additionally, they often have a hard time verbalizing their symptoms and will frequently keep it to themselves for fear of being misunderstood or labeled as “crazy” or “faking it.” This can make it challenging to make an accurate diagnosis. In the case of small children, who often have difficulty in expressing themselves, encouraging them to draw what they see can be helpful. Fortunately, people can often outgrow AIWS, or the symptoms can be well controlled through managing the underlying condition.

Osman Farooq, MD is a board-certified child neurologist and epileptologist at UBMD Department of Neurology (UBMD Neurology), Director of the Pediatric Neuromuscular clinic at Buffalo’s Oishei Children’s Hospital (OCH), and runs the Pediatric Concussion Center at both OCH and UBMD Neurology. Dr. Farooq treats patients for a variety of neurologic symptoms, evaluates and manages epileptic and non-epileptic (stress-induced) seizures and neuromuscular disorders, and has a special interest in the causes of stroke in young people. He is particularly grateful to Edward J. Fine, MD for his part in Alice in Wonderland Syndrome research they both conducted. Dr. Fine is a board-certified neurologist and neurophysiologist, now retired from clinical practice, and a current professor emeritus. Both are faculty members in the Department of Neurology at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences. To make an appointment to see Dr. Farooq, call 716-932-6080.