Hippocampal abnormalities and seizures: a 16-year single center review of sudden unexpected death in childhood, sudden u
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ORIGINAL ARTICLE
Hippocampal abnormalities and seizures: a 16-year single center review of sudden unexpected death in childhood, sudden unexpected death in epilepsy and SIDS Fu Chuen Kon 1,2 & Rita Zapata Vázquez 3 & Andrew Lang 1 & Marta C Cohen 1,4 Accepted: 19 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Sudden Unexpected Death in Childhood (SUDC) is the unexplained death of children aged between 1 and 18 years old. Hippocampal abnormalities have previously been described in Sudden Unexpected Death in Epilepsy (SUDEP) and it is possible that SUDC shares similar pathogenic mechanisms with SUDEP. Our aim was to determine the prevalence of hippocampal abnormalities, history of seizures and demographic features in our caseload of SUDC, SUDEP and SIDS cases. A review of post-mortem reports from 2003 to 2018 was carried out to identify cases of SUDC, SUDEP and SIDS. Histological evidence of hippocampal abnormalities, patient demographics (age, gender), sleeping position, and past medical history (history of seizures and illness 72 hours prior to death) were recorded. Statistical analysis was performed to compare the three groups. 48 SUDC, 18 SUDEP and 358 SIDS cases were identified. Hippocampal abnormalities associated with temporal lobe epilepsy were found in 44.4% of SUDC cases. 5/15 SUDC cases with a history of seizures demonstrated hippocampal abnormalities. SUDC cases were also more likely to be found prone compared to SIDS cases. In comparison with SIDS, both SUDC and SUDEP cases were more likely to demonstrate hippocampal abnormalities (SUDC: (OR = 9.4, 95% CI: 3.1–29.1, p < 0.001; SUDEP: OR = 35.4, 95% CI: 8.3–151.5, p < 0.001). We found a potential link between hippocampal abnormalities and epileptic seizures in SUDC. A concerted effort should be directed towards consistent sampling and standardized description of the hippocampus and clinical correlation with a history of seizures/epilepsy in postmortem reports. Keywords Hippocampus . Seizures . Sudden infant death syndrome . Sudden unexpected death in childhood . Sudden unexpected death in epilepsy
Introduction Sudden Unexpected Death in Childhood (SUDC) is the sudden death of a healthy child aged between 1 and 18 years old which remains unexplained after reviewing the clinical histo-
* Marta C Cohen [email protected] 1
Histopathology Department, Sheffield Children’s Hospital NHS FT, Sheffield, UK
2
Medical School, University of Sheffield, Sheffield, UK
3
Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Mexico
4
Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
ry, circumstances of death, performance of a complete autopsy and ancillary testing [1, 2]. SUDC is most common between the ages of 1 and 4 and accounts for 1.3/100,000 deaths per year in this age range [3–5]. The Centre for Disease Control estimates that SUDC is 50.7 to 600 times less common than Sudden Infant Death Syndrome (SIDS), the leading cause of death in infancy [2]. Krous et al. analyzed 50 SUDC c
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