Subacute encephalopathy with seizures in alcoholics (SESA) syndrome: a subtype of focal non-convulsive status epilepticus

Focal status epilepticus is often associated with intracranial infections, neoplasms or vascular aetiologies. Subacute encephalopathy with seizures in alcoholics (SESA) syndrome is a clinically under-recognised disorder characterised by encephalopathy in the context of seizure and specific focal EEG abnormalities. Our case involved a male in his 50s with a history of alcohol use disorder, who presented with left-sided twitching and encephalopathy, found to be in a focal status. An EEG revealed abnormal discharges in the right frontoparietal region. MRI of the brain displayed signal changes in the right cerebral hemisphere, hippocampus and thalamus. A fluorodeoxyglucose positron emission tomography showed hypometabolism in the bilateral cerebral cortices. The final diagnosis of SESA was made after a comprehensive evaluation. The patient improved in both his symptoms and interval MRI after initiation of appropriate anti-seizure medications.