one recommended approach is to encourage children to draw their visual illusions during episodes. cases that are suspected should warrant tests and exams such as blood tests, ecg, brain mri, and other antibody tests for viral antibody detection. differential diagnosis requires three levels of conceptualization. symptoms need to be distinguished from other disorders that involve hallucinations and illusions. it is usually easy to rule out psychosis as those with alice in wonderland syndrome are typically aware that their hallucinations and distorted perceptions are not 'real'. once these symptoms are distinguished and identified, the most likely cause needs to be established. finally, the diagnosed condition needs to be evaluated to see if the condition is responsible for the symptoms that the individual is presenting. given the wide variety of metamorphopsias and other distortions, it is not uncommon for alice in wonderland syndrome to be misdiagnosed or confused with other etiologies. anatomical relation an area of the brain that is important to the development of alice in wonderland syndrome is the temporal-parietal-occipital carrefour (tpo-c), where tpo-c region is the meeting point of temporooccipital, parietooccipital, and temporoparietal junctions in the brain. the tpo-c region is also crucial as it is the location where somatosensory and visual information are interpreted by the brain to generate any internal or external manifestations. thus, modifications to these regions of the brain may trigger the cause of alice in wonderland syndrome and body schema disorders simultaneously . depending on which portion of the brain is damaged, the symptoms of alice in wonderland syndrome may differ. for example, it has been reported that injury to the anterior portion of the brain is more likely to be correlated to more complex and a wider range of symptoms, whereas damage to the occipital region has mainly been associated with only simple visual disturbances. prognosis the symptoms of alice in wonderland syndrome themselves are not inherently harmful and are often not frightening to the person experiencing them. since there is no established treatment for alice in wonderland syndrome, the prognosis varies from patient to patient and is based on whether an underlying cause has been identified. in cases of alice in wonderland syndrome caused by underlying conditions, symptoms typically occur during the underlying disease and last anywhere from a few days to months. in most cases, symptoms of alice in wonderland syndrome disappear either spontaneously, with the treatment of underlying causes, or after reassurances that symptoms are momentary and harmless. some people do not experience any more episodes of symptoms after their first experience, while others have repeat episodes before symptoms resolve. other people continued to experience episodes years after the initial experience, sometimes with the development of new visual disorders or migraines. treatment at present (2017), alice in wonderland syndrome has no standardized treatment plan. since symptoms of alice in wonderland syndrome often disappear, either spontaneously on their own, or with the treatment of the underlying disease, most clinical and non-clinical alice in wonderland syndrome cases are considered to be benign. in cases of alice in wonderland syndrome caused by underlying chronic disease, however, symptoms tend to reappear during the active phase of the underlying cause (e.g., migraine, epilepsy). if treatment of alice in wonderland syndrome is determined necessary and useful, it should be focused on treating the suspected underlying disease. treatment of these underlying conditions mostly involves prescription medications such as antiepileptics, migraine prophylaxis, antivirals, or antibiotics. antipsychotics are rarely used in treating alice in wonderland syndrome symptoms due to their minimal effectiveness. migraine prophylaxis treatment methods revolving around migraine prophylaxis include medications and following a low-tyramine diet. drugs that may be used to prevent migraines include anticonvulsants, antidepressants, calcium channel blockers, and beta blockers. other treatments that have been explored for migraines include repetitive transcranial magnetic stimulation (rtms). however, further research is needed to establish the effectiveness of this treatment regime. epidemiology the lack of established diagnostic criteria or large-scale epidemiological studies, low awareness of the syndrome, and the unstandardized diagnosis criteria and definition for alice in wonderland syndrome mean that the exact prevalence of the syndrome is currently unknown. one study on 3,224 adolescents in japan demonstrated the occurrence of macropsia and micropsia to be 6.5% in boys and 7.3% in girls, suggesting that the symptoms of alice in wonderland syndrome may not be particularly rare. this also seems to suggest a difference in the male-to-female ratio of people with alice in wonderland syndrome. however, according to other studies, it appears that the male/female ratio is dependent on the age range being observed. studies showed that younger males (age range of 5 to 14 years) were 2.69 times more likely to experience alice in wonderland syndrome than girls of the same age, while there were no significant differences between students of 13 to 15 years of age. conversely, female students (16- to 18-year-olds) showed a significantly greater prevalence. alice in wonderland syndrome is more frequently seen in children and young adults. the average age of the start of alice in wonderland syndrome is six years old, but it is typical for some people to experience the syndrome from childhood up to their late twenties. because many parents who have alice in wonderland syndrome report their children having it as well, the condition is thought possibly to be hereditary. some parents report not realizing they have experienced alice in wonderland syndrome symptoms until after their children have been diagnosed, further indicating that many cases of alice in wonderland syndrome likely go unrecognized and under-reported. research is still being expanded upon and developed on this syndrome in a multitude of different regions and specialties. future studies are encouraged to include global collaborative efforts that may help improve understanding of alice in wonderland syndrome and its epidemiology. history the syndrome is sometimes called todd's syndrome, about a description of the condition in 1955 by dr. john todd (1914–1987), a british consultant psychiatrist at high royds hospital at menston in west yorkshire. dr. todd discovered that several of his patients experienced severe headaches causing them to see and perceive objects as greatly out of proportion. in addition, they had altered sense of time and touch, as well as distorted perceptions of their own body. despite having migraine headaches, none of these patients had brain tumors, damaged eyesight, or mental illness that could have accounted for these and similar symptoms. they were all able to think lucidly and could distinguish hallucinations from reality, however, their perceptions were distorted. dr. todd speculated that author lewis carroll had used his own migraine experiences as a source of inspiration for his famous 1865 novel alice's adventures in wonderland. carroll's diary reveals that, in 1856, he consulted william bowman, an ophthalmologist, about the visual manifestations of the migraines he regularly experienced. in carroll's diaries, he often wrote of a "bilious headache" that came coupled with severe nausea and vomiting. in 1885, he wrote that he had "experienced, for the second time, that odd optical affection of seeing moving fortifications, followed by a headache". carroll wrote two books about alice, the heroine after which the syndrome is named. in the story, alice experiences several strange feelings that overlap with the characteristics of the syndrome, such as slowing time perception. in chapter two of alice's adventures in wonderland (1865), alice's body shrinks after drinking from a bottle labeled "drink me", after which she consumed a cake that made her so large that she almost touched the ceiling. these features of the story describes the macropsia and micropsia that are so characteristic to this disease. these symptoms have been reported before in scientific literature, including world war i and ii soldiers with occipital lesions, so todd understood that he was not the first person to discover this phenomenon. additionally, as early as 1933, other researchers such as coleman and lippman had compared these symptoms to the story of alice in wonderland. caro lippman was the first to hypothesize that the bodily changes that alice encounters mimicked those of lewis carroll's migraine symptoms. others suggest that carroll may have familiarized himself with these distorted perceptions through his knowledge of hallucinogenic mushrooms. it has been suggested that carroll would have been aware of mycologist mordecai cubitt cooke's description of the intoxicating effects of the fungus amanita muscaria (commonly known as the fly agaric or fly amanita), in his books the seven sisters of sleep and a plain and easy account of british fungi. society and culture gulliver's travels alice in wonderland syndrome's symptom of micropsia has also been related to jonathan swift's novel gulliver's travels. it has been referred to as "lilliput sight" and "lilliputian hallucination", a term coined by british physician raoul leroy in 1909. alice in wonderland alice in wonderland syndrome was named after lewis carroll's 19th-century novel alice's adventures in wonderland. in the story, alice, the titular character, experiences numerous situations similar to those of micropsia and macropsia. the thorough descriptions of metamorphosis clearly described in the novel were the first of their kind to depict the bodily distortions associated with the condition. there is some speculation that carroll may have written the story using his own direct experience with episodes of micropsia resulting from the numerous migraines he was known to experience. it has also been suggested that carroll may have had temporal lobe epilepsy. house the condition is diagnosed in the season 8 episode "risky business". doctors in april 2020, a case of alice in wonderland syndrome was covered in an episode of the bbc daytime soap opera doctors, when patient hazel gilmore (alex jarrett) experienced it.