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Sudden and unexpected death in epilepsy: neuropathological findings and HSP‐70 immunohistochemistry
Author(s) -
Thom M.,
Seetah S.,
Scaravilli F.
Publication year - 2002
Publication title -
neuropathology and applied neurobiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.538
H-Index - 95
eISSN - 1365-2990
pISSN - 0305-1846
DOI - 10.1046/j.1365-2990.2002.39286_50.x
Subject(s) - epilepsy , hippocampal sclerosis , medicine , neocortex , hippocampus , temporal lobe , hippocampal formation , pathology , atrophy , sudden death , psychiatry
Patients with epilepsy can die suddenly and unexpectedly with no cause of the death being ascertained at postmortem (SUDEP). The majority of SUDEP cases are not witnessed but there is strong evidence that it is a seizure‐related event. The risk factors and mechanisms of SUDEP are under study. In our series of 41 SUDEP cases between the years 1992 and 2001, the mean age at death was 42 years; the majority of deaths were unwitnessed, with 15 patients found dead in bed. In six patients, seizures were reported in the previous 24 h. Neuropathological findings included old cerebral cortical contusions (eight), cerebellar atrophy (17) and, in 15 cases, a potential epileptogenic pathology was identified, such as hippocampal sclerosis or cortical malformation. We investigated the presence of HSP‐70 protein expression in SUDEP in the hippocampus and temporal lobe as a potential indicator of a recent cerebral insult. Our control groups were non‐SUDEP sudden deaths and non‐SUDEP epilepsy deaths. Immunopositive neurons were identified in hippocampal subfields or neocortex in SUDEP cases as evidence of acute neuronal damage. Positive neurons were also demonstrated in some control groups, however, and the distribution of immunopositivity was compared.