Epileptic seizures in nonalcoholic Wernicke’s encephalopathy: a case report and literature review

Abstract

Wernicke encephalopathy (WE) is characterized by eye signs, cerebellar dysfunction, and confusion. Epileptic seizures are rare in nonalcoholic WE. We reviewed the clinical, laboratory, radiological, and prognostic characteristics of nonalcoholic WE accompanied by epileptic seizures. We reported 1 case and searched similar cases using PubMed, WoK, Ovid, and Embase. WE was diagnosed according to dietary deficiencies, clinical symptoms and brain magnetic resonance imaging (MRI). We reviewed 13 patients (median age, 27 years; 5 men) with clear histories of thiamine deficiency and symptoms of typical WE. The type of epileptic seizures reported in the 13 cases reviewed was generically reported as seizures or convulsions in 4 patients; 7 patients had generalized tonic-clonic seizures, 1 partial seizure, and 1 generalized convulsive status epileptics. Two patients had epileptic seizures as the first symptom of WE. Laboratory tests mainly indicated metabolic acidosis and electrolyte disturbances. Electroencephalography may present as normal patterns, increased slow waves or epileptic discharge. Six patients had cortical lesions on brain MRI. These lesions were usually diffuse and band-like, and sometimes involved all lobes either symmetrically or asymmetrically, with the frontal lobe as the most susceptible area. All cortical lesions were accompanied by non-cortical lesions typical of WE. Brain MRI abnormalities, after thiamine treatment, mostly disappeared on follow-up MRIs. The patients had good prognoses. Only 1 patient had repeated seizures, and there were no comas or deaths. Patients with nonalcoholic WE accompanied by seizures are young and generally have good prognoses. Most patients experienced generalized convulsive seizures, which may have been related to abnormal cerebral cortical metabolism due to subacute thiamine deficiency.

Seizure as a presenting manifestation of Wernicke's encephalopathy induced by hyperemesis gravidarum

“…Till date only 13 cases have been reported due to non-alcoholic WE presenting with epileptic seizures in literature. [ 6 ] Only two of them presented with seizures as an initial manifestation (our case is the third reported case in this regard) and only six of those cases had cortical lesions (ours is the seventh being reported). In our case, both cortical and bilateral thalamus involvement explained the source of seizure activity even in the absence of any demonstrable electrolyte imbalance.…”

Seizure as the Main Manifestation of Nonalcoholic Wernicke’s Encephalopathy but Without Cortical Involvement: A Case Report

“…A recent literature review reported 14 cases of nonalcoholic Wernicke’s encephalopathy with seizure. Only six of those displayed cortical involvement [ 1 ]. Among those patients, only three had seizures as the initial presentation.…”

“…We believe that this is a good case to report as a seizure as the initial presentation of WE was reported only in 14 cases in the English literature. This case also shows that early thiamine replacement can result in significant neurological improvement [1]. In this case report, we aim to review what the English literature has to answer the questions about the differences between alcoholic and nonalcoholic WE, the risk factors of nonalcoholic WE, the typical and atypical MRI findings, and the prevalence of seizure and cortical lesion in WE.…”

Thiamine Alleviates Cognitive Impairment and Epileptogenesis by Relieving Brain Inflammation in PTZ-induced Kindling Rat Model

“…Remarkably, cases of Wernicke encephalopathy have been reported, which are epileptic seizures that improve after thiamine treatment. (Fu et al 2017;Shang et al 2017). It has also been suggested that severe thiamine de ciency may cause epilepsy in infants (Fattal-Valevski et al 2009a).…”