background The Alice in Wonderland syndrome (aiws) was conceptualised in 1955 as a group of distortions of visual perception, the body schema and the experience of time. Although 60 years have passed since then, very little is known yet about the syndrome. This is surprising since the aiws has important diagnostic and therapeutic implications.
aim To provide an overview of the literature on the aiws.
method For this review, a literature search was carried out in PubMed and the historical literature.
results The search yielded 70 papers with a total of 169 case descriptions. As these papers indicate, the aiws has many causes, the main ones being neurological, infectious and substance-related; sometimes the causes are psychiatric. Among adults and elderly patients the disorders described are mainly neurological; among young people encephalitis is fairly common. Treatment needs to be directed at the (assumed) underlying condition, although in almost half of the cases the patient's main requirement is reassurance rather than treatment. Prevalence rates are unknown, but studies in the general population indicate that the symptoms of the aiws occur more frequently than previously assumed.
conclusion Clinical suspicion of an aiws warrants careful auxiliary investigations and – whenever necessary – treatment. The aiws should not be confused with schizophrenia spectrum disorders and other perceptual disorders, and it deserves to be included in the research agenda of international classifications such as the dsm and icd.