THE NEUROLOGICAL PHENOMENON OF ALICE IN WONDERLAND SYNDROME
Issues of Rehabilitation Orthopaedics Neurophysiology and Sport Promotion – IRONS November 26, 2025 DOI: 10.19271/irons-000224-2025-50 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Population | Patients with Alice in Wonderland Syndrome described in epidemiological studies and case reports |
| Interventions | Triptans antiepileptics SSRIs cognitive-behavioral therapy |
| Key findings | AIWS most commonly presents with micropsia and macropsia, altered time perception, derealization, and depersonalization; micropsia was reported in 73% of cases, mean onset age was 8.3 years, and migraines were present in 90% of patients. The authors conclude that AIWS is underdiagnosed and that management should address the underlying condition, most commonly migraine, with psychological support for psychiatric comorbidities. |
Abstract
Introduction: Alice in Wonderland Syndrome (AIWS) is a rare neurological disorder characterized by distortions in the perception of size, time, and spatial relationships. Named after Lewis Carroll’s novel, the condition has been known since the 1950s, yet its underlying mechanisms remain incompletely understood. AIWS is frequently associated with migraine, epilepsy, and viral infections.
Aim: The aim of this paper was to provide a comprehensive review of AIWS, including its pathophysiology, clinical manifestations, potential causes, diagnostic approaches, and treatment strategies. Material and Methods This review is based on scientific literature, including 17 epidemiological studies and case reports. It also incorporates neuroimaging data and symptom assessment scales.
Results: The most common symptoms of AIWS include micropsia and macropsia, altered time perception, derealization, and depersonalization. Micropsia was reported in 73% of cases. The condition is more commonly diagnosed in children, with a mean onset age of 8.3 years. Migraines were present in 90% of patients. Treatment involves pharmacotherapy (e.g., triptans, antiepileptics, SSRIs) and non-pharmacological methods, such as cognitive-behavioral therapy.
Conclusions: AIWS is a complex disorder that requires further research to better understand its pathophysiology and optimize treatment strategies. Neuroimaging studies suggest the involvement of occipital and temporal lobes and dysregulation of neurotransmitter systems, including serotonin, dopamine, and GABA. Due to the variability and transient nature of symptoms, AIWS is often underdiagnosed. Effective management should address the underlying condition—most commonly migraine—and include psychological support when psychiatric comorbidities are present.