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Biassoni E, Bellucci M, Micalizzi E, Miggino M, Andorno E, Porcile E, Resaz M, Roccatagliata L, Castellan L, Villani F, Ferrari A. The role of EEG and neuroimaging in the diagnosis of non-convulsive status epilepticus in Subacute Encephalopathy with Seizures in Alcoholics (SESA syndrome): a case report and overview of the literature. Neurol Sci 2024:10.1007/s10072-024-07609-2. [PMID: 38802690 DOI: 10.1007/s10072-024-07609-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
Epileptic seizures are frequently associated with liver dysfunction and alcoholism. Subacute encephalopathy with seizures in chronic alcoholics (SESA) is an underrecognized condition with peculiar clinical, EEG and neuroradiological features.We report the case of a 58-year-old man with previous alcohol use disorder (AUD) and acute-on chronic liver failure on alcohol-related cirrhosis, referred for urgent Orthotopic Liver Transplantation evaluation. The patient presented with delirium, aphasia and progressive deterioration of consciousness leading to intensive care unit admission. EEG showed slow activity with superimposed lateralized periodic discharges (LPDs) over the left temporo-occipital regions and ictal discharges with focal motor phenomena, consistent with focal status epilepticus. Antiseizure treatment with lacosamide and levetiracetam was administered with progressive improvement of consciousness.Brain MRI disclosed T2/FLAIR areas of hyperintensity in the left pulvinar and T2/FLAIR hyperintensity with corresponding DWI hyperintensity in the left hippocampal cortex, suggestive of post/peri-ictal excitotoxic changes with anatomical correspondence to focal LPDs distribution. SWI demonstrated decreased prominence of cortical veins in the left temporo-occipital region consistent with increased venous blood oxygenation in compensatory hyperperfusion.In conclusion, SESA should be suspected in the differential diagnosis of patients with AUD presenting with focal neurological deficits, seizures and focal EEG abnormalities. In this context, EEG and brain MRI represent useful tools with both diagnostic and prognostic value.
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Affiliation(s)
- Erica Biassoni
- Department of Neuroscience, Neurorehabilitation, Ophthalmology, Genetics, and Mother and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Margherita Bellucci
- Department of Neuroscience, Neurorehabilitation, Ophthalmology, Genetics, and Mother and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Elisa Micalizzi
- Neurophysiology Unit and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Marco Miggino
- HBP and Liver Transplant Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Enzo Andorno
- HBP and Liver Transplant Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Porcile
- Postoperative Intensive Care Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martina Resaz
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Roccatagliata
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Lucio Castellan
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Flavio Villani
- Neurophysiology Unit and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Ferrari
- Neurophysiology Unit and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Fernández-Torre JL, Kaplan PW. Subacute Encephalopathy With Seizures in Alcoholics Syndrome: A Subtype of Nonconvulsive Status Epilepticus. Epilepsy Curr 2019; 19:77-82. [PMID: 30955427 PMCID: PMC6610417 DOI: 10.1177/1535759719835676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A recent assessment of the classification of nonconvulsive status epilepticus (NCSE) has incorporated the specific electroencephalographic (EEG) patterns on a syndromic basis. Such a clinical EEG syndromic approach may enable more accurate and expedited diagnosis of particular subtypes of NCSE so as to improve therapy. Herein, we review the characteristics of subacute encephalopathy with seizures in alcoholics syndrome, a subtype of focal NCSE occurring in chronic alcoholism with specific features, including encephalopathy, lateralized periodic discharges on the EEG, chronic microvascular ischemia on neuroimaging studies, and possible recurrence when chronic antiseizure treatment is stopped.
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Affiliation(s)
- José L Fernández-Torre
- 1 Department of Clinical Neurophysiology, Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain.,2 Department of Physiology and Pharmacology, University of Cantabria (UNICAN), Santander, Cantabria, Spain.,3 Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Peter W Kaplan
- 4 Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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