Amygdala sclerosis in sudden and unexpected death in epilepsy

Sclerosis of the amygdala is a not uncommon finding in patients with chroni c epilepsy. The amygdala has efferent connections, via the central nuclei, to cardioregulatory centres in the medulla. Experimental studies have sugge sted that damage to the central nucleus may be of functional significance i n patients with sudden and unexpected death in epilepsy (SUDEP) in particul ar with regard to their susceptibility to cardiac arrhythmias. We investiga ted this possibility by carrying out a quantitative immunohistochemical ana lysis of the patterns of neuronal loss and gliosis in three amygdala subnuc lei (central, basal and lateral) in post mortem material from 15 SUDEP case s and seven normal controls. We identified significant neuronal loss in the medial division of the lateral amygdaloid nucleus in SUDEP cases but not i n central or basal nuclei. These patterns of cell loss in the amygdala do n ot differ from previous studies in both humans and animal models of chronic epilepsy suggesting that there is not a specific pattern of amygdaloid scl erosis in SUDEP patients which could implicate a functional role for this n ucleus in the mechanism of the sudden death. (C) 1999 Elsevier Science B.V. All rights reserved.