SESA syndrome: synthesizing evidence and proposing diagnostic criteria and severity grading—a scoping review

BACKGROUND: Subacute Encephalopathy with Seizures in Alcoholics (SESA) syndrome is an underrecognized neurological complication among chronic alcohol users, characterized by subacute encephalopathy, seizures, focal neurological deficits, and distinctive EEG and neuroimaging findings. Despite advancements, gaps remain in standardized diagnosis, therapeutic management, and long-term outcomes. OBJECTIVES: This scoping review aims to synthesize published evidence on the clinical presentation, EEG and neuroimaging findings, management strategies, and outcomes of SESA syndrome, while proposing refined diagnostic criteria and a severity grading scale. METHODS: Studies reporting adult patients with chronic alcohol abuse presenting with SESA syndrome, as defined by the co-occurrence of encephalopathy, seizures, and focal deficits with supporting EEG or neuroimaging findings, were included. All study designs were eligible; reviews, commentaries, and editorials without original data were excluded. A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, relevant grey literature, and conference abstracts from January 1981 to April 2025. Reference lists of included articles were manually screened. Data were extracted independently into standardized forms for demographics, clinical features, diagnostics, management, and outcomes. Quality appraisal used the Joanna Briggs Institute checklist. RESULTS: Forty-five patient cases from 29 studies were included. SESA syndrome presents with a consistent triad, varied seizure types, hallmark EEG LPDs, and reversible MRI abnormalities. Proposed criteria and severity scale may facilitate early recognition and guide management. CONCLUSIONS: SESA syndrome requires heightened awareness and multidisciplinary management. Future research should validate proposed diagnostic tools and elucidate pathophysiology and long-term outcomes.