Assessing the role of Subacute Encephalopathy with Seizures in Alcoholics (SESA) syndrome in the development of status epilepticus: a case report and systematic review with individual patients' analysis.

backgroundSubacute Encephalopathy with Seizures in Alcoholics (SESA) is a rare neurological syndrome characterized by altered mental status, periodic EEG discharges, and neuroimaging abnormalities, typically occurring in individuals with chronic alcohol use. Its progression to status epilepticus (SE), including refractory and super-refractory forms, is poorly documented.

methodsWe present a super-refractory status epilepticus (SRSE) case in a patient with confirmed SESA and conduct a systematic review of the literature to explore the relationship between SESA and SE. A systematic literature review was performed using MEDLINE (accessed through PubMed), Scopus, EMBASE and Google Scholar, in accordance with the PRISMA guidelines. Data were extracted on demographics, EEG and imaging findings, treatment approaches, and outcomes.

resultsOur patient developed SRSE in the setting of chronic hepatic dysfunction. The patients responded to a combination of propofol and ketamine and obtained long-term seizure control with vagus nerve stimulation (VNS). Type 3 oligoclonal bands were detected in the CSF, although it is considered a non-specific marker of neuroinflammation. The literature review identified 7 cases of SE in SESA, with variable clinical presentations. While levetiracetam and valproic acid were the most employed treatments, benzodiazepines were notably absent from first-line protocols. Phenytoin and lacosamide resulted as favorable alternatives.

conclusionSE in the context of SESA requires tailored therapeutic strategies due to hepatic comorbidities and diagnostic ambiguity with NCSE. Our report supports the cautious use of propofol and ketamine in SRSE, as well as the efficacy of VNS in long-term seizure control.