AUTHOR=Yan Fengping , Zhang Fu , Yan Yanan , Zhang Le , Chen Yuanyuan 

TITLE=Sudden unexpected death in epilepsy: Investigation of autopsy-based studies

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1126652

DOI=10.3389/fneur.2023.1126652

ISSN=1664-2295

ABSTRACT=Epilepsy is a common neurological disorder associated with increased morbidity and mortality. Sudden unexpected death in epilepsy (SUDEP) is one of the most common causes for epilepsy-related deaths and its characteristics remain largely unknown, particularly from a forensic autopsy perspective. The present study aimed to investigate the neurological, cardiac and pulmonary findings for a total of 388 SUDEP decedents encompassing three cases from our forensic center during 2011-2020 and 385 literature-reported autopsy cases. In our cases, two presented with only mild cardiac abnormalities, such as focal myocarditis, mild coronary atherosclerosis of the left anterior coronary artery. The third one was negative of any pathological findings. After pooling together these SUDEP cases, we found that neurological changes (n=218 cases, 56.2 %) were the most common postmortem findings associated with SUDEP, with cerebral edema/congestion (n=60 cases, 15.5%) and old traumatic brain injury (n=58 cases, 14.9%) being the leading findings. Interstitial fibrosis, myocyte disarray/hypertrophy and mild coronary artery atherosclerosis were the primary cardiac pathology, documented in 49 (12.6%), 18 (4.6%) and 15 (3.9%) cases, respectively. Nonspecific pulmonary edema was the major finding in lungs. This is the first autopsy-based study that reports the scenario of postmortem findings for SUDEP cases. Our study paves way for understanding the SUDEP pathogenesis and death interpretation.