18F-FDG PET in Epilepsy

  • Ismini C. Mainta
  • Fabienne Picard
  • Valentina Garibotto
Part of the Clinicians’ Guides to Radionuclide Hybrid Imaging book series (CGRHI)


This chapter will summarize the evidence supporting the clinical use of FDG-PET brain imaging in the evaluation of patients with pharmaco-resistant epilepsy considered for surgical treatment. We will discuss the clinical indications, the main patterns of hypometabolism observed, and the main advantages and limitations associated with its use.


  1. 1.
    Scheffer IE, Berkovic S, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):512–21.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Gschwind M, Seeck M. Modern management of seizures and epilepsy. Swiss Med Wkly. 2016;146:w14310.PubMedGoogle Scholar
  3. 3.
    Kwan P, Arzimanoglou A, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069–77.PubMedGoogle Scholar
  4. 4.
    de Tisi J, Bell GS, et al. The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study. Lancet. 2011;378(9800):1388–95.PubMedGoogle Scholar
  5. 5.
    Duncan JS. Imaging in the surgical treatment of epilepsy. Nat Rev Neurol. 2010;6(10):537–50.PubMedGoogle Scholar
  6. 6.
    Mouthaan BE, Rados M, et al. Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe. Epilepsia. 2016;57(5):770–6.PubMedGoogle Scholar
  7. 7.
    ILAE. ILAE Neuroimaging Commission recommendations for neuroimaging of patients with epilepsy. Epilepsia. 2005;38(s10):1–2.Google Scholar
  8. 8.
    Lascano AM, Perneger T, et al. Yield of MRI, high-density electric source imaging (HD-ESI), SPECT and PET in epilepsy surgery candidates. Clin Neurophysiol. 2016;127(1):150–5.PubMedGoogle Scholar
  9. 9.
    Von Oertzen J, Urbach H, et al. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. J Neurol Neurosurg Psychiatry. 2002;73(6):643–7.Google Scholar
  10. 10.
    Kumar A, Chugani HT. The role of radionuclide imaging in epilepsy, Part 1: Sporadic temporal and extratemporal lobe epilepsy. J Nucl Med. 2013a;54(10):1775–81.PubMedGoogle Scholar
  11. 11.
    Kumar A, Chugani HT. The role of radionuclide imaging in epilepsy, Part 2: Epilepsy syndromes. J Nucl Med. 2013b;54(11):1924–30.PubMedGoogle Scholar
  12. 12.
    Chassoux F, Rodrigo S, et al. FDG-PET improves surgical outcome in negative MRI Taylor-type focal cortical dysplasias. Neurology. 2010;75(24):2168–75.PubMedGoogle Scholar
  13. 13.
    Carne RP, O’Brien TJ, et al. MRI-negative PET-positive temporal lobe epilepsy: a distinct surgically remediable syndrome. Brain. 2004;127.(Pt 10:2276–85.PubMedGoogle Scholar
  14. 14.
    Li LM, Cendes F, et al. Surgical outcome in patients with epilepsy and dual pathology. Brain. 1999;122. (Pt 5:799–805.PubMedGoogle Scholar
  15. 15.
    la Fougere C, Rominger A, et al. PET and SPECT in epilepsy: a critical review. Epilepsy Behav. 2009;15(1):50–5.PubMedGoogle Scholar
  16. 16.
    Wieser HG. The role of PET in the diagnosis of epilepsies. Epileptologie. 2004;21:109–16.Google Scholar
  17. 17.
    Guedj E, Bonini F, et al. 18FDG-PET in different subtypes of temporal lobe epilepsy: SEEG validation and predictive value. Epilepsia. 2015;56(3):414–21.PubMedGoogle Scholar
  18. 18.
    Juhasz C, Nagy F, et al. Glucose and [11C]flumazenil positron emission tomography abnormalities of thalamic nuclei in temporal lobe epilepsy. Neurology. 1999;53(9):2037–45.PubMedGoogle Scholar
  19. 19.
    Semah F. PET imaging in epilepsy: basal ganglia and thalamic involvement. Epileptic Disord. 2002;4(Suppl 3):S55–60.PubMedGoogle Scholar
  20. 20.
    Chang CP, Yen DJ, et al. Unilateral thalamic hypometabolism in patients with temporal lobe epilepsy. J Formos Med Assoc. 2008;107(7):567–71.PubMedGoogle Scholar
  21. 21.
    Kim YK, Lee DS, et al. (18)F-FDG PET in localization of frontal lobe epilepsy: comparison of visual and SPM analysis. J Nucl Med. 2002;43(9):1167–74.PubMedGoogle Scholar
  22. 22.
    Wang K, Liu T, et al. Comparative study of voxel-based epileptic foci localization accuracy between statistical parametric mapping and three-dimensional stereotactic surface projection. Front Neurol. 2016;7:164.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Mendes Coelho VC, Morita ME, et al. Automated online quantification method for (18)F-FDG positron emission tomography/CT improves detection of the epileptogenic zone in patients with pharmacoresistant epilepsy. Front Neurol. 2017;8:453.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Savic I, Altshuler L, et al. Localized cerebellar hypometabolism in patients with complex partial seizures. Epilepsia. 1996;37(8):781–7.PubMedGoogle Scholar
  25. 25.
    Conrad GR, Sinha P. FDG PET imaging of subependymal gray matter heterotopia. Clin Nucl Med. 2005;30(1):35–6.PubMedGoogle Scholar
  26. 26.
    Morioka T, Nishio S, et al. Functional imaging in periventricular nodular heterotopia with the use of FDG-PET and HMPAO-SPECT. Neurosurg Rev. 1999;22(1):41–4.PubMedGoogle Scholar
  27. 27.
    Chugani HT, Conti JR. Etiologic classification of infantile spasms in 140 cases: role of positron emission tomography. J Child Neurol. 1996;11(1):44–8.PubMedGoogle Scholar
  28. 28.
    Chandra PS, Salamon N, et al. FDG-PET/MRI coregistration and diffusion-tensor imaging distinguish epileptogenic tubers and cortex in patients with tuberous sclerosis complex: a preliminary report. Epilepsia. 2006;47(9):1543–9.PubMedGoogle Scholar
  29. 29.
    Chugani HT, Mazziotta JC, et al. The Lennox-Gastaut syndrome: metabolic subtypes determined by 2-deoxy-2[18F]fluoro-D-glucose positron emission tomography. Ann Neurol. 1987;21(1):4–13.PubMedGoogle Scholar
  30. 30.
    You SJ, Lee JK, et al. Epilepsy surgery in a patient with Lennox-Gastaut syndrome and cortical dysplasia. Brain and Development. 2007;29(3):167–70.PubMedGoogle Scholar
  31. 31.
    Sarikaya I. PET studies in epilepsy. Am J Nucl Med Mol Imaging. 2015;5(5):416–30.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Chassoux F, Artiges E, et al. (18)F-FDG-PET patterns of surgical success and failure in mesial temporal lobe epilepsy. Neurology. 2017;88(11):1045–53.PubMedGoogle Scholar
  33. 33.
    Wong CH, Bleasel A, et al. The topography and significance of extratemporal hypometabolism in refractory mesial temporal lobe epilepsy examined by FDG-PET. Epilepsia. 2010;51(8):1365–73.PubMedGoogle Scholar
  34. 34.
    Wong CH, Bleasel A, et al. Relationship between preoperative hypometabolism and surgical outcome in neocortical epilepsy surgery. Epilepsia. 2012;53(8):1333–40.PubMedGoogle Scholar
  35. 35.
    Hinde S, Soares M, et al. The added clinical and economic value of diagnostic testing for epilepsy surgery. Epilepsy Res. 2014;108(4):775–81.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Desarnaud S, Mellerio C, et al. (18)F-FDG PET in drug-resistant epilepsy due to focal cortical dysplasia type 2: additional value of electroclinical data and coregistration with MRI. Eur J Nucl Med Mol Imaging. 2018;45(8):1449–60.PubMedGoogle Scholar
  37. 37.
    Salamon N, Kung J, et al. FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy. Neurology. 2008;71(20):1594–601.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Hodolic M, Topakian R, et al. (18)F-fluorodeoxyglucose and (18)F-flumazenil positron emission tomography in patients with refractory epilepsy. Radiol Oncol. 2016;50(3):247–53.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Meltzer CC, Adelson PD, et al. Planned ictal FDG PET imaging for localization of extratemporal epileptic foci. Epilepsia. 2000;41(2):193–200.PubMedGoogle Scholar
  40. 40.
    Garibotto V, Heinzer S, et al. Clinical applications of hybrid PET/MRI in neuroimaging. Clin Nucl Med. 2013;38(1):e13–8.PubMedGoogle Scholar
  41. 41.
    Grouiller F, Delattre BM, et al. All-in-one interictal presurgical imaging in patients with epilepsy: single-session EEG/PET/(f)MRI. Eur J Nucl Med Mol Imaging. 2015;42(7):1133–43.PubMedGoogle Scholar
  42. 42.
    Paldino MJ, Yang E, et al. Comparison of the diagnostic accuracy of PET/MRI to PET/CT-acquired FDG brain exams for seizure focus detection: a prospective study. Pediatr Radiol. 2017;47(11):1500–7.PubMedGoogle Scholar
  43. 43.
    Shin HW, Jewells V, et al. Initial experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy. Seizure. 2015;31:1–4.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ismini C. Mainta
    • 1
    • 2
  • Fabienne Picard
    • 2
    • 3
  • Valentina Garibotto
    • 1
    • 2
  1. 1.Nuclear Medicine and Molecular Imaging Division, Department of Medical ImagingUniversity Hospitals of GenevaGenevaSwitzerland
  2. 2.Faculty of MedicineGeneva UniversityGenevaSwitzerland
  3. 3.EEG and Epilepsy Unit, Neurology DepartmentUniversity Hospitals of GenevaGenevaSwitzerland

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