Seizures In Alcoholics Research Articles

Teaching NeuroImage: Subacute Encephalopathy With Seizures in Alcoholics (SESA)-Related Abnormalities on EEG and MRI.

A 72-year-old woman with alcohol use disorder (last drink 1 week prior) and no seizure history was admitted with encephalopathy. Admission MRI demonstrated focal, edematous T2 FLAIR hyperintensities (Figure 1), and EEG showed abundant lateralized periodic discharges (LPDs) (Figure 2). Evaluation for other etiologies was negative. Treatment with multiple antiseizure medications (ASMs) led to significant clinical and radiographical improvement.

Use, Abuse, and Associated Impacts of Alcohol on Health and Crimes in Nepal

Alcohol is a socially acceptable and widely available drink in most countries. Its excessive consumption is linked to various health issues, increase in crime rate and even loss of life. This puts heavy strain in low-income countries like Nepal where full medical facilities are still out of reach for most of the population. Therefore, in this article, we have provided an overview of (i) the effect of alcohol on public health; (ii) trend data on alcohol seizures; (iii) alcohol (including methanol) positive forensic cases; and (iv) other alcohol associated crimes. Our analysis is drawn from a range of data types and sources, triangulating the collected data with alcohol specific academic and grey literature, a survey with students and insights from stakeholder engagements in Nepal. We have shown that alcohol has been associated with a range of health-related issues and crime types in Nepal. For example, alcohol was the most mentioned compound in the student survey (50.7%; n=418) followed by other drugs in Drugs Facilitated Sexual Assault cases. We have also discussed issues with adulteration, surrogates and sub-standard alcohol, highlighting the need for strict monitoring, regulations and extra vigilance about quality control of alcohol in circulation. This should be supported by public awareness campaigns on the use, abuse and impacts of alcohol.

Subacute encephalopathy with seizures in alcoholics (SESA) syndrome – a subtype of non-convulsive status epilepticus (NCSE). (4817)

Subacute encephalopathy with seizures in alcoholics (SESA) syndrome – a subtype of non-convulsive status epilepticus (NCSE). (4817)

Postictal diffusion abnormalities of the thalamus in subacute encephalopathy and seizures in alcoholics (SESA)

Postictal diffusion abnormalities of the thalamus in subacute encephalopathy and seizures in alcoholics (SESA)

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

PurposeTo describe additional cases of subacute encephalopathy with seizures in alcoholics (SESA) syndrome, and to question the clinical and radiological course. MethodsWe 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. ResultsFive 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. ConclusionSESA 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.

A pathophysiologic approach for subacute encephalopathy with seizures in alcoholics (SESA) syndrome

Subacute encephalopathy with seizures in alcoholics (SESA) syndrome is a unique disease entity characterized by typical clinical and electroencephalographic (EEG) features in the setting of chronic alcoholism. We present two patients with distinctive serial MRI and EEG findings which suggest a clue to the underlying pathophysiologic mechanisms of SESA syndrome. Two patients with chronic alcoholism and alcoholic liver cirrhosis presented with generalized seizures and confused mental status. Brain MRI demonstrated restricted diffusion, increased T2-weighted signal intensity, and hyperperfusion in the presumed seizure focus and nearby posterior regions of the cerebral hemispheres. EEG showed periodic lateralized epileptiform discharges which were prominent in the posterior regions of the cerebral hemispheres ipsilateral to the side of brain MRI abnormalities. Even after patients clinically improved, these brain abnormalities persisted with progressive atrophic changes on follow-up brain MRI. These patients had not only the distinguishing clinical and EEG features of SESA syndrome, but also showed novel brain MRI abnormalities. These changes on MRI displayed characteristics of seizure-related changes. The posterior dominance of abnormalities on MRI and EEG suggests that the pathophysiologic mechanisms of SESA syndrome may share those of posterior reversible encephalopathy syndrome.

Subacute encephalopathy with seizures in alcoholics (SESA syndrome) revisited

PurposeThe aim of this paper is to describe two additional cases of subacute encephalopathy with seizures in alcoholics (SESA syndrome), and to propose that this entity now should be considered as a subtype of nonconvulsive status epilepticus (NCSE). MethodsWe retrospectively analyzed the clinical characteristics, electroencephalography (EEG), neuroimaging data, and prognosis of these two further cases of SESA syndrome. In addition, we compare our findings with the cases previously described in the English literature in order to propose new diagnostic criteria. ResultsTwo adults with history of chronic alcohol abuse were admitted because of confusion and seizures. A routine EEG showed frequent periodic lateralized epileptiform discharges (PLEDs) localized over the right temporal regions. In one case, we captured two complex partial seizures (CPSs) arising from the right hemisphere. Neuroimaging studies revealed subjacent chronic vascular pathology. Following transfer to the intensive care unit (ICU), both improved to antiepileptic treatment and were discharged with full recovery. ConclusionOn the basis of our findings and a review of the literature, we suggest that SESA syndrome represents a subtype of partial or localization-related NCSE given its particular clinical, electroencephalographic, neuroimaging and prognostic characteristics.

Subacute encephalopathy and seizures in alcoholics (SESA) presenting with non-convulsive status epilepticus

Subacute encephalopathy with seizures in chronic alcoholism (SESA) was first described in 1981 by Niedermeyer who reported alcoholic patients presenting with confusion, seizures and focal neurological deficits and is quite distinct from patients presenting with typical alcohol withdrawal seizures. EEG often reveals periodic discharges and spikes, but SESA presenting with non-convulsive status epilepticus has rarely been described. We report a case of SESA with non-convulsive status epilepticus in a patient who was initially suspected of having a typical alcohol withdrawal seizure. A 61 year old woman with a history of chronic alcoholism was admitted at an outside hospital for confusion thought to be secondary to an alcohol withdrawal seizure. She had right hemiparesis and later developed right facial twitching that did not respond to intravenous fosphenytoin and levetiracetam. She was transferred for further management. Upon arrival, lorazepam and fosphenytoin were given and right face clonic movements resolved. However, continuous EEG monitoring revealed ongoing non-convulsive status epilepticus (NCSE). Following treatment with IV valproate and lacosamide, there was resolution of NCSE. SESA is likely an under recognized clinical syndrome that is quite distinct from typical alcohol withdrawal seizures and requires a different diagnostic and management approach. NCSE is likely to account for the encephalopathy and focal neurological deficits seen in patients presenting with the clinical syndrome of SESA. Therefore, a high degree of suspicion is warranted and continuous EEG monitoring is recommended for alcoholic patients with encephalopathy and focal neurological deficits.

Multiple reversible MRI abnormalities associated with SESA syndrome

The authors report the imaging findings in a patient with a long history of alcoholism, who presented with delirium and recurrent left hemiparesis meeting the criteria of subacute encephalopathy with seizures in alcoholics (SESA) syndrome. MRI revealed fully reversible signal intensities (T2, diffusion-weighted imaging with a decreased apparent coefficient) throughout the right hemisphere. This case suggests that the MRI characteristics of SESA syndrome resemble those of status epilepticus.

Complex partial status epilepticus is an unrecognised feature in SESA syndrome: new insights into its pathophysiology

We report a patient diagnosed as having subacute encephalopathy with frequent seizures in alcoholics (SESA syndrome), in which recurrent, non-convulsive seizures of frontal origin contributed significantly to the alteration of the mental state. Our case suggests that the occurrence of episodes of complex partial status epilepticus (CPSE) may contribute greatly to the origin and pathophysiology of the confusional state in this rare, epileptic entity.

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

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.

Family-based and case–control association studies of glutamate receptor GRIK3 Ser310Ala polymorphism in Polish patients and families with alcohol dependence

The aim of this study was to evaluate the role of the GRIK3 functional polymorphism (Ser310Ala) in the pathogenesis of alcoholism. This polymorphism was investigated in two types of studies: (1) the association study in a whole group of alcoholics (116 patients fulfilling ICD-10 alcohol dependence (AD) criteria and 255 controls, Polish descent) and homogenous overlapping subgroups of patients with: a history of delirium tremens and/or alcohol seizures, early age of onset of alcoholism (AOO < 26 years), a co-occurrence of dissocial personality disorder, a history of familial alcoholism; (2) the family-based study (using Transmission Disequilibrium Test (TDT) in 100 Polish families with alcohol dependence). The history of alcoholism was obtained using SSAGA (Polish version). GRIK3 functional polymorphism was determined using PCR. TDT revealed an adequate transmission of both alleles to the affected offspring in the whole group of alcohol families (29 × Ser, 24 × Ala; χ 2 = 0.472; d.f. = 1; p = 0.492) and in the homogenous subgroups of families. No significant associations between any of the above mentioned alcohol phenotypes and Ser310 allele were observed (the whole AD group: p = 0.66 AD with delirium and/or seizures: p = 0.521; early onset AD: p = 0.868; AD with familial history of alcoholism: p = 0.798 and AD with dissocial personality disorder: p = 0.618). These findings do not seem to support the hypothesis of the role of this polymorphism in the pathogenesis of alcoholism.

Alcohol-related seizures and the kindling effect of repeated detoxifications: the influence of cocaine.

The purpose of this study was to determine if individuals with concurrent alcohol and cocaine use differ in regard to seizure risk compared to individuals who abuse only alcohol, and to explore the relationship between multiple detoxifications and seizure risk in the context of concurrent cocaine use. In this study, alcoholic cocaine users had a decreased risk of seizure compared to alcoholics without cocaine use (P < 0.005). Seizures were rare in individuals who did not abuse alcohol. Alcoholic cocaine users reported a younger age at first seizure compared to alcoholics without cocaine use (P < 0.04). Alcoholic patients with seizures had significantly more previous detoxification experiences compared to matched alcoholic patients without seizures (P = 0.0001). Concurrent cocaine use did not appear to have an independent effect on the risk of seizure. The findings in this study suggest that concurrent cocaine use may accelerate the development of alcohol-related seizures in predisposed individuals but does not appear to substantially increase overall risk. Multiple previous detoxifications are associated with an increased risk of seizures in alcoholics both with and without concurrent cocaine use.

Withdrawal seizures in alcoholics. A transverse and longitudinal investigation.

74 heavy drinkers, divided in two groups by positive or negative history for withdrawal seizures, were evaluated on the history, clinical, biochemical, CT, EEG and psychometric investigations. Some of them have been followed up for 20 months. The results suggest the possible role of a constitutional predisposition for withdrawal seizures.