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Todd syndrome

Todd syndrome or Alice in Wonderland Syndrome (AIWS) is a strange perceptual disorder, primarily involving visual and somesthetic (bodily sensations) integration. This strange experience was first described by ‘Lewis Carroll’ in his book ‘Alice in Wonderland’ and this literary suggestion was first reported by Todd. AIWS is a rare condition that causes temporary episodes of disorientation and distorted perception. In 1950s Dr. John Todd noted that the symptoms and recorded anecdotes which were experienced by Alice in Wonderland’s character have a close resemblance to these episodes. Alteration of visual perception is experienced in such a way that the sizes of body parts or any other objects are perceived incorrectly.

AIWS can occur at any age but occurs mainly in children and young adults: it can also be experienced in adulthood. Along with visual perception, tactile and auditory perception can also be distorted. Time may seem to pass either slower or faster than actual time. These episodes aren’t due to dysfunction of eyes or a hallucination. AIWS episodes can be experienced differently by each person. Generally each episode lasts for few minutes but some can last up to 30 minutes too.  

There are several symptoms of Alice in Wonderland syndrome but none of them occur simultaneously, each symptom is separate.  

- Micropsia (objects appear smaller than normal)
- Teleopsia (objects appear further away than they actually are)
- Macropsia (objects appear larger than normal)
- Metamorphopsia (straight lines appear wavy, warped, or blank)
- Pelopsia (objects appear nearer than they actually are) 

Cause / Risk Factor

The majority of patients with the AIWS have a family history of Migraine or have an overt migraine themselves. The exact causes for AIWS are still not known but few of them can be-  

- Typical migraine
- Epstein-Barr virus infections- It is most common virus in human body which spreads through bodily fluids mainly saliva.
- Temporal lobe epilepsy
- Brain Tumors
- Use of hallucinogenic drugs
- Stress
- Stroke  

Symptoms

- Migraine episodes- People who experience migraines are more likely to experience AIWS. Some researchers or doctors believe that AIWS maybe a rare subtype of migraine.
- Distorted body image
Altered perception of time.
- Metamorphopsia (Visual defects)
- Distorted perception of size
- Feverish symptoms
- Epileptic seizures- they affect only one part of the brain  

Treatments

According to a 2016 systematic review, ‘doctors rarely prescribe antipsychotics because, despite the nature of the syndrome, there is no psychosis in AIWS’.

There is no treatment for AIWS. If a child is experiencing AIWS, the only way is to control the symptoms and wait for them to pass. Treating the underlying causes of AIWS episodes may prevent future AIWS episodes.

If stress is the cause of the AIWS episodes, it can be reduced with medication or relaxation.