Subacute encephalopathy with seizures in alcoholics (SESA syndrome)

Last revised by Rohit Sharma on 21 Feb 2024

Subacute encephalopathy with seizures in alcoholics (SESA syndrome) is a rare complication of chronic alcohol use that can present with seizures and a variety of neurological deficits. 

SESA syndrome is rare and seen in alcoholics who are not undergoing withdrawal 1-3

SESA syndrome is characterized by 1,3,4:

  1. confusion

  2. transient neurological deficits

  3. seizure

    • usually generalized tonic-clonic or focal motor seizures

    • non-convulsive status epilepticus 3

Seizures are accompanied by prominent EEG abnormalities (e.g. lateralized periodic discharges) 1-4.

No specific features are visible on imaging of the central nervous system although features of chronic alcohol excess and other often associated co-morbidities are not-surprisingly common (e.g. chronic small vessel ischemic change, generalized atrophy) 3,4.

If imaged acutely with MRI following substantial seizure activity, cortical or hippocampal T2 hyperintensity, minor swelling and even reduced ADC values may be seen attributable to post-ictal cytotoxic edema and hyperemia 3,4

As patients with a history of SESA syndrome are prone to seizure recurrence, treatment with antiseizure medications is usually prescribed 3,4

SESA syndrome was first described by Niedermeyer et al. in 1981 2

As there are no specific imaging features, no specific imaging differential diagnosis can be proposed although other causes of neurological deficits and seizures should be sought (e.g. tumors). 

Clinically, the main differential is that of seizures from other complications of alcohol excess (particularly alcohol withdrawal syndrome and Marchiafava-Bignami disease). With the exception of alcohol withdrawal, which will also have no specific imaging features, these conditions generally have distinct imaging features. Conditions to be considered, therefore, include 3,4:

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