Long-term outcome of Alice-in-Wonderland-Syndrome: Results from a case series of 12 patients

Purpose: There are several reports of so called Alice-in-Wonderland-syndrome mostly concerning differenzial diagnosis and aetiology. So far there are no reports on the long-term outcome of these patients. From a parental point of view this however is a very important information.

Methods: Between January 2003 and December 2008 all patients presenting to our hospital with Alice-in-Wonderland-syndrome were included in our data base and contacted for follow-up in regular intervals.

Results: During the 6 year period 12 patients with Alice-in-Wonderland-syndrome presented at our hospital. The mean age was 9.3 years (SD±1.8) ranging from 6 to 11 years. All patients included were male. Five patients (41.7%) had a family history of migraine or epilepsy and in one case the father was reported to have had similar symptoms during childhood. Serology for Epstein-Barr virus infection was available in four cases but was not indicative for acute infection in either of these. Three patients (20%) were lost to follow-up. In all remaining cases symptoms of Alice-in-Wonderland-syndrome had ceased within one week to four months. Only two patients (22.2%) experienced additional episodes of metamorphic hallucinations after a symptom-free interval of three years and one year, respectively.

Conclusion: According to our observations Alice-in-Wonderland-syndrome seems to be a benign and self-terminating childhood condition, although occasional recurrence of symptoms is possible. The increased prevalence of a positive family history for migraine and epilepsy is suggestive for a hereditary predisposition.