Quintieri Paolo, Dono Fedele, Evangelista Giacomo, Corniello Clarissa, Cipollone Sara, De Angelis Sibilla, Ferretti Antonio, Sensi Stefano L
Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
Epilepsy Center, Neurology Institute "SS Annunziata" University Hospital, University of Chieti-Pescara, Chieti, Italy.
Eur J Neurol. 2025 Apr;32(4):e70101. doi: 10.1111/ene.70101.
Sudden Unexpected Death in Epilepsy (SUDEP) is the most common cause of death in patients with poorly controlled epilepsy. To date, a higher risk of developing SUDEP is mainly identified by clinical factors, among which generalized tonic-clonic seizures and their frequency stand out as part of the highly debated SUDEP-7 Scoring. This review investigates the role of neuroimaging-based approaches as a tool to help predict SUDEP.
We carried out a systematic search of the literature to identify multimodal neuroimaging modifications (i.e., MRI, fMRI, PET, and SPECT) in patients with epilepsy who died from SUDEP. The following databases were used: PubMed and Google Scholar. The review was registered on the PROSPERO platform (Registration code: CRD42024558765).
Fifteen articles were selected, investigating 104 SUDEP cases compared with 792 non-SUDEP epileptic patients and 280 healthy controls (HC) (overall mean age 33.9 ± 1.6). Results suggest that SUDEP and non-SUDEP cases and HC differ anatomically and functionally. In the SUDEP population, MRI data indicate relevant volume differences in the gray matter of the hippocampus and cerebellar cortices. In addition, functional imaging reveals discrepancies in network modulation within the brainstem and its relationship with several cortical structures. Although less consistent, PET and SPECT scan data point toward alterations in metabolism and perfusion in the frontal and brainstem areas.
The reviewed data support correlations between the occurrence of SUDEP and neuroimaging multimodal alterations that could be relevant in death prediction.
癫痫性猝死（SUDEP）是癫痫控制不佳患者最常见的死亡原因。迄今为止，SUDEP发生风险较高主要通过临床因素来识别，其中全身强直阵挛发作及其发作频率作为备受争议的SUDEP-7评分的一部分尤为突出。本综述探讨基于神经影像学的方法作为帮助预测SUDEP的工具的作用。
我们对文献进行了系统检索，以确定死于SUDEP的癫痫患者的多模态神经影像学改变（即MRI、fMRI、PET和SPECT）。使用了以下数据库：PubMed和谷歌学术。该综述已在PROSPERO平台注册（注册号：CRD42024558765）。
共筛选出15篇文章，研究了104例SUDEP病例，并与792例非SUDEP癫痫患者和280例健康对照（HC）进行比较（总体平均年龄33.9±1.6）。结果表明，SUDEP病例、非SUDEP病例和HC在解剖结构和功能上存在差异。在SUDEP人群中，MRI数据显示海马体和小脑皮质灰质存在显著的体积差异。此外，功能成像揭示了脑干内网络调节的差异及其与几个皮质结构的关系。尽管一致性较差，但PET和SPECT扫描数据表明额叶和脑干区域存在代谢和灌注改变。
综述数据支持SUDEP的发生与神经影像学多模态改变之间的相关性，这些改变可能与死亡预测相关。
