What is AWS? Alice in Wonderland syndrome (AWS) is a rare condition that causes temporary episodes of distorted perception and disorientation. You may feel larger or smaller than you actually are. You may also find that the room you’re in — or the surrounding furniture — seems to shift and feel further away or closer than it really is. These episodes aren’t the result of a problem with your eyes or a hallucination. They’re caused by changes in how your brain perceives the environment you’re in and how your body looks. This syndrome can affect multiple senses, including vision, touch, and hearing. You may also lose a sense of time. Time may seem to pass faster or slower than you think. AWS primarily affects children and young adults. Most people grow out the disordered perceptions as they age, but it’s still possible to experience this in adulthood. AWS is also known as Todd’s syndrome. That’s because it was first identified in the 1950s by Dr. John Todd, a British psychiatrist. He noted that the symptoms and recorded anecdotes of this syndrome closely resembled episodes that the character Alice Liddell experienced in Lewis Carroll’s novel “Alice’s Adventures in Wonderland.”

How does AWS present? AWS episodes are different for each person. What you experience may vary from one episode to the next as well. A typical episode lasts a few minutes. Some can last up to half an hour. During that time, you may experience one or more of these common symptoms: Migraine People who experience AWS are more likely to experience migraines. Some researchers and doctors believe AWS is actually an aura. This is an early sensory indication of a migraine. Others believe AWS may be a rare subtype of migraine. Size distortion Micropsia is the sensation that your body or objects around you are growing smaller. Macropsia is the sensation that your body or objects around you are growing larger. Both are common experiences during an episode of AWS. Perceptual distortion If you feel that objects near you are growing larger or that they’re closer to you than they really are, you’re experiencing pelopsia. The opposite of that is teleopsia. It’s the sensation that objects are getting smaller or farther away from you than they really are. Time distortion Some people with AWS lose their sense of time. They may feel time is moving faster or slower than it really is. Sound distortion Every sound, even typically quiet sounds, seems loud and intrusive. Loss of limb control or loss of coordination This symptom occurs when muscles feel as if they’re acting involuntarily. In other words, you may feel as though you’re not controlling your limbs. Likewise, the altered sense of reality can affect how you move or walk. You may feel uncoordinated or have difficulty moving about as you normally would.

What causes AWS? It’s not clear what causes AWS, but doctors are trying to better understand it. They do know that AWS isn’t a problem with your eyes, a hallucination, or a mental or neurological illness. Researchers believe unusual electrical activity in the brain causes abnormal blood flow to the parts of the brain that process your environment and experience visual perception. This unusual electrical activity may be the result of several causes. One study found that 33 percent of people who experienced AWS had infections. Both head trauma and migraines were tied to 6 percent of AWS episodes. But more than half of AWS cases had no known cause. Although more research is needed, migraine is considered the leading cause for AWS in adults. Infection is considered the primary cause for AWS in children. Other possible causes include: stress

cough medicine

use of hallucinogenic drugs

epilepsy

stroke

brain tumor

Are there associated conditions or other risk factors? Several conditions are linked to AWS. The following may increase your risk for it: Migraines. AWS may be a type of aura, or a sensory warning of a coming migraine. Some doctors also believe AWS may be a subtype of migraines.

AWS may be a type of aura, or a sensory warning of a coming migraine. Some doctors also believe AWS may be a subtype of migraines. Infections. AWS episodes may be an early symptom of the Epstein-Bar virus (EBV). This virus can cause infectious mononucleosis, or mono.

AWS episodes may be an early symptom of the Epstein-Bar virus (EBV). This virus can cause infectious mononucleosis, or mono. Genetics. If you have a family history of migraines and AWS, you may have a higher risk for experiencing this rare condition.

How is AWS diagnosed? If you’re experiencing symptoms like the ones described for AWS, make an appointment with your doctor. You and your doctor can review your symptoms and any related concerns. There isn’t any one test that can help diagnose AWS. Your doctor may be able to make a diagnosis by ruling out other possible causes or explanations for your symptoms. To do this, your doctor may perform: MRI scan. An MRI can produce highly detailed images of your organs and tissues, including the brain.

An MRI can produce highly detailed images of your organs and tissues, including the brain. Electroencephalography (EEG). An EEG can measure the electrical activity of the brain.

An EEG can measure the electrical activity of the brain. Blood tests. Your doctor can rule out or diagnose viruses or infections that could be causing AWS symptoms, such as EBV. AWS may be underdiagnosed. This is because the episodes — which often last only a few seconds or minutes — may not rise to a level of concern for people experiencing them. This is especially true with young children. The fleeting nature of the episodes can also make it difficult for doctors to study AWS and better understand its effects.

What treatment options are available? There’s no treatment for AWS. If you or your child experiences symptoms, the best way to handle them is to rest and wait for them to pass. It’s also important to reassure yourself or your loved one that the symptoms aren’t harmful. Treating what you and your doctor suspect is the underlying cause for AWS episodes may help prevent an episode. For example, if you experience migraines, treating them may prevent future episodes. Likewise, treating an infection could help stop the symptoms. If you and your doctor suspect stress plays a role, you may find that meditation and relaxation can help reduce symptoms.

Can AWS lead to complications? AWS often gets better over time. It rarely causes any complications or problems. Although this syndrome isn’t predictive of migraines, you’re more likely to develop them if you have these episodes. According to one study, a third of people without a history of migraine headaches developed them after experiencing AWS.