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Postmortem MRI reveals distinct structural features in sudden unexpected death in epilepsy.
Andrea Hill1,2, Fenglai Xiao1,2, Maria Thom1,2
1Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
Epilepsia Open
|May 8, 2026
Summary
Postmortem MRI revealed larger hippocampal and amygdala volumes in sudden unexpected death in epilepsy (SUDEP) cases compared to non-SUDEP deaths. These findings suggest postmortem MRI may help identify SUDEP-related brain changes.
Area of Science:
- Neurology
- Neuroimaging
- Epilepsy Research
Background:
- Sudden unexpected death in epilepsy (SUDEP) lacks definitive biomarkers.
- In vivo MRI abnormalities in epilepsy patients may predict SUDEP risk.
- Postmortem MRI (PM-MRI) can differentiate SUDEP-related changes from other postmortem alterations.
Purpose of the Study:
- To investigate structural brain differences using PM-MRI in individuals who died from SUDEP versus other causes.
- To assess the potential of PM-MRI as an objective tool for identifying SUDEP.
Main Methods:
- Performed PM-MRI on nine individuals: five suspected SUDEP, two epilepsy (non-SUDEP), and two sudden cardiac death.
- Quantified hippocampal, amygdala, and subcortical volumes using validated segmentation.
- Compared PM-MRI volumes with 70 healthy in vivo controls.
Main Results:
- SUDEP cases exhibited significantly larger hippocampal (p=0.014) and amygdala (p=0.023) volumes compared to non-SUDEP cases.
- Most SUDEP cases showed volumes exceeding healthy control means, while non-SUDEP cases had volume reductions.
- Findings align with in vivo MRI observations in high-risk SUDEP individuals.
Conclusions:
- PM-MRI reveals distinct volumetric differences in SUDEP cases, particularly enlarged limbic structures.
- These structural changes parallel in vivo findings, suggesting transient peri- or postictal alterations.
- PM-MRI offers a potential objective method for identifying SUDEP, complementing clinical risk factors.
