To describe a cohort of 20 cases of Alice in Wonderland Syndrome from an academic child neurology service.

Twenty patients, ages 5-21 years, were identified with AIWS:  11 female (56%) and 9 male (44%).  Four patients had complex partial epilepsy; 3 had with prolonged aura with migraine and 1 with multiple contusions.  1 patient had AIWS with sleep deprivation and  1 during episodes of pseudotumor cerebri. Ten had symptoms during febrile or infectious states from several etiologies including infectious  mononucleosis and borreliosis. Nine patients had EEG performed, 4 of which were abnormal. Sharp waves and/or discharges localized to frontal, temporal or occipital lobes.

Etiologies of AIWS are multifactorial.  We report the first cases of AIWS occurring after concussions and another linked to pseudotumor cerebri.  AIWS patients 13 years and younger had infective or febrile etiologies.   AIWS patients, ages 13-21, mostly had epilepsy or headache. Prompt recognition of AIWS phenomena led to appropriate and effective therapy.  Reassurances and/or explanations without medication alleviated anxieties of patients and parents.  Detailed summaries of unique cases will be provided at presentation. To our knowledge this is the largest cohort of patients reported from a single academic center.