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

Abstract 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.