Evidence map›Paper›PMID 42101226›Full record

ArticleEpilepsia open2026

Postmortem MRI reveals distinct structural features in sudden unexpected death in epilepsy.

Andrea Hill, Fenglai Xiao, Maria Thom, David Maudgil, Hannah Bergman, John S Duncan, Owen J Arthurs, Josemir W Sander, Beate Diehl, Matthias J Koepp

Abstract readComparative Study
In one paragraph

Article in Epilepsia open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Andrea HillDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
Fenglai XiaoDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.ORCID https://orcid.org/0000-0003-1308-6539
Maria ThomDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.ORCID https://orcid.org/0000-0001-7712-2629
David MaudgilNIHR Great Ormond Street Biomedical Research Centre, London, UK.
Hannah BergmanDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
John S DuncanDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
Owen J ArthursNIHR Great Ormond Street Biomedical Research Centre, London, UK.
Josemir W SanderDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.ORCID https://orcid.org/0000-0001-6041-9661
Beate DiehlDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.ORCID https://orcid.org/0000-0002-6896-854X
Matthias J KoeppDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.ORCID https://orcid.org/0000-0002-4277-8000

Funding

the National Institute for Health and Care Research (NIHR)the NIHR University College London Hospitals Biomedical Research Centre BRC540/HEI/EA/110410Wellcome TrustWellcome Trust 218380Wellcome Trust 221934/Z/20/Z
6 · The paper itself

Abstract

Magnetic resonance imaging (MRI) abnormalities have been reported in individuals who later die from sudden unexpected death in epilepsy (SUDEP), but their specificity and predictive value remain uncertain. Postmortem MRI (PM-MRI) offers a unique opportunity to distinguish structural features associated with SUDEP from changes related to epilepsy, comorbid illness, or the postmortem interval. We performed PM-MRI in nine individuals: five with suspected SUDEP, two with epilepsy who died from non-seizure-related causes, and two without epilepsy who died from sudden cardiac death. Hippocampal, amygdala, and subcortical volumes were quantified using validated segmentation methods and compared with 70 healthy in vivo controls. Compared with non-SUDEP cases, SUDEP cases showed significantly larger hippocampal (p = 0.014) and amygdala (p = 0.023) volumes, with most exceeding the healthy control mean, whereas non-SUDEP cases consistently demonstrated volume reductions. These findings parallel in vivo MRI observations in individuals at high risk of SUDEP and are consistent with transient peri- or postictal structural changes. In the context of recent large-scale studies showing few validated clinical SUDEP biomarkers beyond frequent generalized tonic-clonic seizures and sleeping alone, PM-MRI may provide an objective approach to positively identifying individuals who died from SUDEP. PLAIN LANGUAGE SUMMARY: We used magnetic resonance imaging (MRI) scans taken after death to study brain changes in people who died from sudden unexpected death in epilepsy (SUDEP). We found that certain brain areas involved in seizure control and automatic body functions, such as breathing and heart rate, were larger in people who died from SUDEP than in people who died from other causes. These changes were similar to those previously seen on brain scans of people with epilepsy who are known to be at higher risk of SUDEP while they were still alive. Our findings suggest that postmortem MRI may help identify brain changes linked to SUDEP.

Indexed as

BrainDeath, SuddenEpilepsyMagnetic Resonance ImagingPostmortem ImagingSudden Unexpected Death in EpilepsyAdultAmygdalaFemaleHippocampusHumansMaleMiddle AgedbiomarkerMRIpost‐mortemSUDEP

Identifiers

PMID42101226
PMCPMC13238599

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.