title: Audit of practice in sudden unexpected death in epilepsy (SUDEP) post mortems and neuropathological findings.
abstract: Sudden unexpected death in epilepsy (SUDEP) is one of the leading causes of death in people with epilepsy. For classification of definite SUDEP, a post mortem (PM), including anatomical and toxicological examination, is mandatory to exclude other causes of death. We audited PM practice as well as the value of brain examination in SUDEP.
  
  
  
  We reviewed 145 PM reports in SUDEP cases from four UK neuropathology centres. Data were extracted for clinical epilepsy details, circumstances of death and neuropathological findings.
  
  
  
  Macroscopic brain abnormalities were identified in 52% of cases. Mild brain swelling was present in 28%, and microscopic pathologies relevant to cause or effect of seizures were seen in 89%. Examination based on whole fixed brains (76.6% of all PMs), and systematic regional sampling was associated with higher detection rates of underlying pathology (P < 0.01). Information was more frequently recorded regarding circumstances of death and body position/location than clinical epilepsy history and investigations.
  
  
  
  Our findings support the contribution of examination of the whole fixed brain in SUDEP, with high rates of detection of relevant pathology. Availability of full clinical epilepsy-related information at the time of PM could potentially further improve detection through targeted tissue sampling. Apart from confirmation of SUDEP, complete neuropathological examination contributes to evaluation of risk factors as well as helping to direct future research into underlying causes.
authors: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.|Department of Neuropathology, National Hospital for Neurology and Neurosurgery, NIHR University College London Hospitals Biomedical Research Centre, London, UK.|NINDS Center for SUDEP Research, University Hospitals Case Medical Center, Department of Neurology Cleveland, OH.
authors: Maria
authors: M
authors: Thom
authors: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.|Department of Neuropathology, National Hospital for Neurology and Neurosurgery, NIHR University College London Hospitals Biomedical Research Centre, London, UK.
authors: Zuzanna
authors: Z
authors: Michalak
authors: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.
authors: Gabriella
authors: G
authors: Wright
authors: Department of Neuropathology, Lancashire Teaching Hospitals, Preston, UK.
authors: Timothy
authors: T
authors: Dawson
authors: Department of Cellular Pathology, Derriford Hospital, Plymouth, UK.
authors: David
authors: D
authors: Hilton
authors: Department of Neuropathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors: Abhijit
authors: A
authors: Joshi
authors: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.|Department of Neurology, National Hospital for Neurology and Neurosurgery, NIHR University College London Hospitals Biomedical Research Centre, London, UK.
authors: Beate
authors: B
authors: Diehl
authors: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.|Department of Neurology, National Hospital for Neurology and Neurosurgery, NIHR University College London Hospitals Biomedical Research Centre, London, UK.|Epilepsy Society, Buckinghamshire, UK.
authors: Matthias
authors: M
authors: Koepp
authors: NINDS Center for SUDEP Research, University Hospitals Case Medical Center, Department of Neurology Cleveland, OH.
authors: Samden
authors: S
authors: Lhatoo
authors: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.|Department of Neurology, National Hospital for Neurology and Neurosurgery, NIHR University College London Hospitals Biomedical Research Centre, London, UK.|Epilepsy Society, Buckinghamshire, UK.|NINDS Center for SUDEP Research, University Hospitals Case Medical Center, Department of Neurology Cleveland, OH.|Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
authors: Josemir W
authors: JW
authors: Sander
authors: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.|Department of Neurology, National Hospital for Neurology and Neurosurgery, NIHR University College London Hospitals Biomedical Research Centre, London, UK.|Epilepsy Society, Buckinghamshire, UK.|NINDS Center for SUDEP Research, University Hospitals Case Medical Center, Department of Neurology Cleveland, OH.
authors: Sanjay M
authors: SM
authors: Sisodiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000379:methods / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D003645:Death, Sudden / Q000473:pathology*; D004827:Epilepsy / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D000069338:Neuropathology / Q000379:methods / Q000592:standards; D006113:United Kingdom; D055815:Young Adult
keywords: SUDEP; Sudden unexpected death in epilepsy; audit; neuropathology; post mortem