To acquaint neurologists with underrecognized SESA syndrome described as an uncommon variant of non-convulsive status epilepticus in patient with chronic alcohol abuse.

Neurologists are aware of the diversity of neurological syndromes associated with alcoholism. Traditionally, alcohol withdrawal syndrome (AWS), delirium tremens, hepatic encephalopathy, alcoholic hallucinosis, and Wernicke encephalopathy or Korsakoff psychosis are best known. Seizures have best been known to occur in association with alcohol withdrawal syndrome. However often there are seizures and non-convulsive status epilepticus that can occur de novo in patients with chronic alcohol abuse that does not fit the pattern of a withdrawal syndrome. 

A 49-year-old female with h/o alcohol abuse and with no previous h/o seizures presented to the hospital with altered mental status, aphasia and right sided extremity and facial weakness. Patient was noted to have a GTC seizure during the initial evaluation. MRI brain was negative for stroke but revealed signal changes in the left hippocampus and thalamus. CSF studies did not reveal any infections. EEG revealed continuous 1 – 1.5 Hz lateralized left posterior quadrant periodic discharges (LPDs) often with polyspike components raising suspicion for ictal interictal continuum. Patient did not have any convulsive seizures in the hospital and was managed with AEDs with slow improvement in mental status over the next 10 days. 

Our patient had SESA syndrome with typical syndromic association of recent alcohol intake, de novo ictal – interictral continuum / NCSE and prolonged multifactorial confusional state with focal findings.

The SESA syndrome appears as a distinct neurological disorder in which the encephalopathy occurs in the context of focal motor or GTCSs but often not proximate to alcohol cessation . Underrecognized SESA may present as NCSE with focal clinical, EEG and imaging abnormalities, warranting expedited diagnosis and antiseizure treatment to minimize morbidity.