Objective:

The purpose of this case series is to describe the clinical and electrophysiological features of SESA syndrome presenting as focal seizures mimicking dyskinesias and myoclonus, and to emphasize the importance of early recognition and management.

Background: Subacute Encephalopathy with Seizures in Alcohol consumers (SESA) syndrome is a rare condition characterized by subacute onset of encephalopathy with seizures, which occurs in chronic alcoholics who abruptly stop or reduce their alcohol intake. SESA syndrome was first described in 1981, and there have been only a few case reports and small case series published in the medical literature

Method: We report a case series of 9 patients with SESA syndrome who presented to a medical teaching hospital in rural Gujarat, India, between 2016 and 2021. The patients had a mean age of 42 years (range 28-62), and all had a history of chronic alcoholism. The most common presenting symptom was focal seizures, which were misinterpreted as chorea-ballism in some cases. Myoclonus was also a common finding. Electroencephalography (EEG) showed diffuse slowing and epileptiform discharges. All patients received treatment with thiamine and anti-epileptic drugs, resulting in significant improvement in symptoms and resolution of abnormal EEG findings

Results:

SESA syndrome can present with focal seizures mimicking dyskinesias and myoclonus, which may be misinterpreted as movement disorders. Early recognition and treatment with thiamine and anti-epileptic drugs can improve prognosis. Clinicians should consider SESA syndrome in the differential diagnosis of patients with subacute encephalopathy and seizures, particularly in chronic alcoholics. The limitations of this case series include the small sample size and the fact that it was conducted in a single center.

Conclusion:

SESA syndrome presenting as focal dyskinesias and myoclonus is a rare condition that requires early recognition and management with thiamine and anti-epileptic drugs. Clinicians should be aware of this condition and consider it in the differential diagnosis of patients with subacute encephalopathy and seizures, particularly in chronic alcoholics.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/subacute-encephalopathy-with-seizures-in-alcohol-consumers-sesa-presenting-as-focal-dyskinesias-and-myoclonus/