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Todd’s syndrome, more frequently referred to as Alice in Wonderland syndrome (AIWS), is a disorienting neurological condition that primarily targets children.

AIWS affects human visual perception and involves an array of symptoms that include transient altered perception of the shapes of inanimate and animate objects  that appear to be smaller (micropsia) or larger (macropsia) than normal.

There can also be an impaired sense of passage of time or the feeling of “zooming” of the surrounding environment. The episodes are predominantly short in duration, often less than an hour, and occur up to several times a day, with unpredictable onset of symptoms. Essentially, patients suffering from AIWS experience distorted time, space, and body image. They feel as though their bodies have been altered in size and they have visual hallucinations.

Dr. John Todd, a British psychiatrist, first described AIWS in 1955. Todd gave it this name by way of the famous novel by Lewis Carroll, Alice’s Adventures in Wonderland, as the illness resembles the events experienced by Alice. Reportedly, Lewis Carroll actually suffered from severe migraines and Lilliputian hallucinations, during which objects and people appear smaller than they actually are.

This rare neurological diagnosis can be confused with drug intoxication or psychosis. In Todd’s paper, he described a singular group of symptoms associated with migraine and epilepsy. Cases of AIWS have been also associated with diagnoses of infectious mononucleosis. The patients he detailed showed no signs of damaged eyesight or brain tumours. The majority of patients with AIWS report a family history of migraines or suffer from migraine themselves.

Documented triggers for an episode of AIWS include, but are not limited to, migraine, stress, brain tumors, Epstein-Barr virus infection, drugs (particularly cough medicine), epilepsy, and infections.

There are no proven treatment methods for AIWS; however, rest and dietary changes are indicated. Most cases of AIWS are self-terminating and resolve by adulthood.

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