Subacute Encephalopathy with Seizures in Alcoholics (SESA Syndrome): Report of an Unusual Case

Abstract

Subacute encephalopathy with seizures in alcoholics (SESA syndrome) is a rare neurologic disorder complicating the chronic abuse of alcohol. This acute or subacute condition is characterized by transient neurologic deficits, seizures and severe lateralized abnormalities on the electroencephalogram (EEG). Our case demonstrates that in SESA syndrome, convulsive (generalized tonic-clonic) and nonconvulsive (complex partial) seizures may coexist.

Subacute encephalopathy with seizures in alcoholics (SESA syndrome) revisited

“…Most authors believe that PLEDs largely represent an interictal phenomenon. In our patient 1 and in others SESA patients described previously by Ferná ndez-Torre et al, 6,7 PLEDs disappeared during focal CPSs and reappeared after seizure resolution, strongly supporting this assumption. However, the patient still may remain confused when PLEDs return on the EEG explaining the co-occurrence of these features, hence a routine EEG recording may encompass a delirium with PLEDs but where seizures are not captured.…”

“…On occasion, single photon emission computed tomography (SPECT) has been helpful in ambiguous cases in demonstrating an epileptic substrate. 6,7 Niedermeyer et al 1 proposed a cerebrovascular cause as the most plausible etiology. Our findings and review of the literature support this hypothesis.…”

Subacute Encephalopathy With Seizures in Alcoholics Syndrome: A Subtype of Nonconvulsive Status Epilepticus

“…2,3 However, it was not until 2006 that Fernández-Torre and colleagues described the occurrence of complex partial seizures (CPSs) and episodes of CPSE. 7,8 Nonetheless, the original description in 1981 noted probable subclinical focal seizures in cases 1, 2, and 5. Recurrences occurred in 3 patients.…”

“…Surprisingly, few cases of SESA syndrome have been reported in the English literature since these early reports. 4–15 When initially described, the cause of delirium remained speculative and early authors assumed a vascular etiology. 2…”

“…Twenty-five years later, Fernández-Torre et al 7,8 reported cases of SESA syndrome with complex partial status epilepticus (CPSE) that had arisen in temporal and extratemporal regions and that was associated with focal deficits and confusion. They suggested that the syndrome was more common than reported and that the existence of CPSE could readily explain the alteration in mental state.…”