In addition to the motor consequences of epilepsy, seizures result in cardiovascular and respiratory consequences that, in some individuals may lead to death. Indeed, Sudden Unexplained Death in Epilepsy (SUDEP) is one of the most poorly understood consequences of epilepsy. By definition, the mechanisms leading to DUSEP are unknown. This Brain Foundation grant builds on the work we have been doing in humans to understand how functional and structural changes in the brain lead to increased cardiovascular risk in various disease states, extending the work to epilepsy. We are the only group in the world using direct microelectrode recordings of sympathetic nerve activity (MSNA) in combination with functional magnetic resonance imaging (fMRI) of the brain to identify areas of the brain responsible for the generation of MSNA. Using this state-of-the-art brain imaging protocol, this research promises to identify changes in the brain associated with epilepsy that increase the probability of SUDEP in certain individuals. By documenting changes in areas of the brain involved in cardiovascular control we hope to be able to identify individuals at risk of SUDEP, ultimately preventing sudden death in epilepsy from occurring.