Although, EEG is accepted as a gold standard only 50% of the patients are safely diagnosed. MRI demonstrates morphologic changes in approximately 80% of patients with epilepsy. Interictal 18F-FDG PET studies show focus-localizing sensitivity ranging from 80 to 85%. Accordingly, we studied the usefulness of interictal FDG PET for detecting epileptic foci compared to structural neuroimaging and EEG findings. A total of 18 patients (7 M and 11 F; mean age 37.8±18.4 years, range 16-77 years) with epilepsy were included in the study. Neurological, FDG-PET/CT, MRI, and EEG examinations were performed. Interictal PET/CT images were acquired starting at 60 min after the intravenous injection of 5.0 mCi of (18) F-fluorodeoxyglucose. Neuroimaging showed abnormal findings in 9 patients. 15 patients had a predominantly unilateral epileptiform focus on EEG. Focal hypometabolism was found in 13 cases. 4p presented with larger hypometabolic areas and 2 had normal brain metabolism despite the epileptic focus on EEG. In 3p the zones of hypermetabolism corresponded to the tumor location. Additional hypometabolic areas were observed in the surrounding regions, which were concordant with the neuroimaging findings of perifocal edema. Based on our own findings and literature review, we suggest that interictal FDG-PET may be an important tool to better understand the neurobiology of seizures and to better define the ictal onset in epilepsy.
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