Abstract
Wernicke encephalopathy (WE) is characterized by eye signs, cerebellar dysfunction, and confusion. Epileptic seizures are rare in nonalcoholic WE. We reviewed the clinical, laboratory, radiological, and prognostic characteristics of nonalcoholic WE accompanied by epileptic seizures. We reported 1 case and searched similar cases using PubMed, WoK, Ovid, and Embase. WE was diagnosed according to dietary deficiencies, clinical symptoms and brain magnetic resonance imaging (MRI). We reviewed 13 patients (median age, 27 years; 5 men) with clear histories of thiamine deficiency and symptoms of typical WE. The type of epileptic seizures reported in the 13 cases reviewed was generically reported as seizures or convulsions in 4 patients; 7 patients had generalized tonic-clonic seizures, 1 partial seizure, and 1 generalized convulsive status epileptics. Two patients had epileptic seizures as the first symptom of WE. Laboratory tests mainly indicated metabolic acidosis and electrolyte disturbances. Electroencephalography may present as normal patterns, increased slow waves or epileptic discharge. Six patients had cortical lesions on brain MRI. These lesions were usually diffuse and band-like, and sometimes involved all lobes either symmetrically or asymmetrically, with the frontal lobe as the most susceptible area. All cortical lesions were accompanied by non-cortical lesions typical of WE. Brain MRI abnormalities, after thiamine treatment, mostly disappeared on follow-up MRIs. The patients had good prognoses. Only 1 patient had repeated seizures, and there were no comas or deaths. Patients with nonalcoholic WE accompanied by seizures are young and generally have good prognoses. Most patients experienced generalized convulsive seizures, which may have been related to abnormal cerebral cortical metabolism due to subacute thiamine deficiency.
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Acknowledgements
This review was supported by the grant from the National Key Clinical Department and Key Discipline of Neurology, the Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases (No. 2014B030301035). We thank the patient and his family for giving us permission to publish his case. We also thank Qiuxin Lv for her assistance in translation of literatures in Japanese and Shen Tao (Zhongshan Ophthalmic Center, Sun Yat-sen University) for his assistance in translation of literature in Korean.
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Wenjin Shang and Xiuhui Chen contributed to the work equally.
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Shang, W., Chen, X., Li, X. et al. Epileptic seizures in nonalcoholic Wernicke’s encephalopathy: a case report and literature review. Metab Brain Dis 32, 2085–2093 (2017). https://doi.org/10.1007/s11011-017-0106-1
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DOI: https://doi.org/10.1007/s11011-017-0106-1