A CASE OF SUBACUTE ENCEPHALOPATHY WITH SE IZURES IN ALCOHOLICS (SESA SYNDROME)

Subacute encephalopathy with seizures in alcoholics (SESA syndrome) is a rare disease entity following chronic alcohol ingestion. It is quit e distinct from alcohol withdrawal syndromes, such as delirium, withdr awal seizures or CNS complications of alcohol, such as Wernicke-Korsak ow syndrome, central pontine myelinolysis or Marchiafava-Bignami disea se, and was proposed in 1981 by Niedermeyer and coworkers. This syndro me consists of multiple neurological deficits, such as hemiparesis or hemianopia,and of recurrent focal and generalized seizures associated with prominent EEG features (periodic lateralized discharges, PLEDs). A 72-year-old Caucasian male with chronic alcoholism and an otherwise unremarkable past medical history was admitted to our hospital because of several secondary generalized simple partial seizures. Laboratory investigations revealed elevated levels of gamma-glutamyl-transpeptida se and of mean corpuscular volume. Other laboratory investigations and the CSF examinations on three occasions revealed normal values. Crani al computed and magnetic resonance tomography showed cerebral microang iopathy and generalized atrophy. Despite triple anticonvulsive therapy and an intravenous treatment with acyclovir and thiamine,the epilepti c seizures persisted. Several EEGs revealed left parietooccipital pero dic lateralized epileptiform discharges (PLEDs). The patient died of a n intercurrent pulmonary infection about 3 months after the onset of s ymptoms. The described clinical picture resembles the symptoms of SESA syndrome.