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.
Similar content being viewed by others
References
Doss A, Mahad D, Romanowski CA (2003) Wernicke encephalopathy: unusual findings in nonalcoholic patients. J Comput Assist Tomogr 27:235–240
Fattal-Valevski A, Kesler A, Sela BA et al (2005) Outbreak of life-threatening thiamine deficiency in infants in Israel caused by a defective soy-based formula. Pediatrics 115:e233–e238
Galvin R, Brathen G, Ivashynka A et al (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 17:1408–1418
Gregory J, Philbrick K, Chopra A (2012) Wernicke encephalopathy in a non-alcoholic patient with metastatic CNS lymphoma and new-onset occipital lobe seizures. J Neuropsychiatr Clin Neurosci 24:E53
Harper CG, Giles M, Finlay-Jones R (1986) Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry 49:341–345
Hiraki A, Kikuchi M (2014) Wernicke's encephalopathy due to excessive intake of isotonic drink; report of 2 cases. No To Hattatsu 46:34–38
Jhala SS, Hazell AS (2011) Modeling neurodegenerative disease pathophysiology in thiamine deficiency: consequences of impaired oxidative metabolism. Neurochem Int 58:248–260
Jung YC, Chanraud S, Sullivan EV (2012) Neuroimaging of Wernicke's encephalopathy and Korsakoff's syndrome. Neuropsychol Rev 22:170–180
Kesler A, Stolovitch C, Hoffmann C et al (2005) Acute ophthalmoplegia and nystagmus in infants fed a thiamine-deficient formula: an epidemic of Wernicke encephalopathy. J Neuroophthalmol 25:169–172
Kwon O-D (2004) Two cases of Wernicke encephalopathy with focal cerebral cortical involvement and convulsive seizure. J Korean Neurol Assoc 22:539–544
Lough ME (2012) Wernicke's encephalopathy: expanding the diagnostic toolbox. Neuropsychol Rev 22:181–194
Manzo G, De Gennaro A, Cozzolino A et al (2014) MR imaging findings in alcoholic and nonalcoholic acute Wernicke's encephalopathy: a review. Biomed Res Int 2014:503–596
Pereira DB, Pereira ML, Gasparetto EL (2011) Nonalcoholic Wernicke encephalopathy with extensive cortical involvement: cortical laminar necrosis and hemorrhage demonstrated with susceptibility-weighted MR phase images. AJNR Am J Neuroradiol 32:E37–E38
Rees JH, Ginsberg L, Schapira AHV (1997) Two pregnant women with vomiting and fits. Am J Obstet Gynecol 177:1539–1540
Sechi G, Serra A (2007) Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 6:442–455
Sechi G, Sechi E, Fois C et al (2016) Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutr Rev 74:281–300
Singh S, Kumar A (2007) Wernicke encephalopathy after obesity surgery: a systematic review. Neurology 68:807–811
Vasconcelos MM, Silva KP, Vidal G et al (1999) Early diagnosis of pediatric Wernicke's encephalopathy. Pediatr Neurol 20:289–294
Verma V, Donadee C, Gomez L et al (2014) Nonalcoholic Wernicke's encephalopathy associated with unintentional weight loss, cholecystectomy, and intractable vomiting: the role of dual thiamine and corticosteroid therapy. Case Rep Neurol Med 2014:430729
Victor M, Adams RD, Collins GH (1971) The Wernicke-Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with post-mortem examinations. Contemp Neurol Ser 7:1–206
Watanabe S, Yamakura S, Hirano K et al (2009) Case of infantile autism with pediatric Wernicke's encephalopathy due to severe eating disorder. No To Hattatsu 41:43–46
Wicklund MR, Knopman DS (2013) Brain MRI findings in Wernicke encephalopathy. Neurol Clin Pract 3:363–364
Wu L, Jin D, Sun X et al (2017) Cortical damage in Wernicke's encephalopathy with good prognosis: a report of two cases and literature review. Metab Brain Dis 32:377–384
Ziemann AE, Schnizler MK, Albert GW et al (2008) Seizure termination by acidosis depends on ASIC1a. Nat Neurosci 11:816–822
Zuccoli G, Pipitone N (2009) Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol 192:501–508
Zuccoli G, Santa Cruz D, Bertolini M et al (2009) MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol 30:171–176
Zuccoli G, Siddiqui N, Bailey A et al (2010) Neuroimaging findings in pediatric Wernicke encephalopathy: a review. Neuroradiology 52:523–529
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Informed consent
Informed consent was obtained from the one case included in the study.
Additional information
Wenjin Shang and Xiuhui Chen contributed to the work equally.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11011-017-0106-1