Development of permanent brain damage after subacute encephalopathy with seizures in alcoholics

Purpose: To describe additional cases of subacute encephalopathy with seizures in alcoholics (SESA) syndrome, and to question the clinical and radiological course.

Methods: We retrospectively analyzed the clinical characteristics, electroencephalography (EEG), MRI studies at the admission and over the following 6 months of 5 cases of SESA syndrome visited our neurology department between 2010 and 2016.

Results: Five middle-aged males with history of chronic alcohol abuse were admitted for confusion, neurological deficit and seizures. Four patients had recurrent partial seizures requiring 2 or more antiepileptic drugs. EEG showed interictal periodic lateralized discharges in 4 patients and focal rhythmic delta activities in 1. Initial MRI studies revealed unilateral hemispheric cortical-subcortical areas of increased T2/ FLAIR signal and restricted diffusion. Follow up examination after 6 months, revealed persistent focal neurological deficits in 3 patients. Follow-up cerebral MRI at 6 months showed a resolution of the hyperintense lesions, but developing focal atrophic changes in all patients.

Conclusion: SESA syndrome should be included among the alcohol-related encephalopathies as a particular pathophysiological entity. The possibility of permanent brain damage should encourage a better clinical awareness of this syndrome to establish prompt diagnosis, relevant investigation and appropriate treatment of recurrent seizures including, if necessary, intensive care unit treatment.