abtin doroudinia, Abbas Yousefi Koma, Jafar Mehvari Habibabadi, Sohrab Hashemi Fesharaki, Nasim Tabrizi, Mehrdad Bakhshayesh Karam, Payam Mehrian




To investigate the role of 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET) in localizing epileptogenic focus of patients with refractory focal epilepsy and normal brain magnetic resonance imaging (MRI).

Material and methods:

In this cross-sectional study, all patients were evaluated clinically and with in-hospital video electroencephalography monitoring (VEM) to localize epileptogenic focus. All patients had unremarkable brain MRI. FDG-PET of brain performed to localize the epileptogenic focus. We used expert visual analysis method in addition to statistical parametric mapping (SPM) and asymmetry index to evaluate brain cortex metabolic activity. We stratified patients with regard to clinical epileptogenic focus as localized in temporal lobe, frontal lobe or partially localized. Finally, clinical and VEM data were compared with FDG-PET results to determine congruence between clinical/VEM data and FDG-PET.


Among patients with temporal lobe epileptogenic focus, 62.5% exact congruency with PET results was documented (p<0.001), contrary to 29.7% incongruence. Patients with frontal lobe epileptogenic focus had only 6.6% exact congruency (p>0.05) and 13.3% partial congruency was documented. Finally, among patients with partially localized seizure focus in one hemisphere, only 6.6% exact congruency (p>0.05) and 53.3% incongruence was demonstrated.



Overall PET results in frontal lobe or partially localized seizure patients were not promising in our study. Although majority of temporal lobe seizure patients demonstrated exactly congruent PET results, these results may be further enhanced by more precise localization of seizure focus with clinical evaluations and VEM, in addition to utilizing more advanced PET imaging software to better quantify and compare PET image findings.


Epilepsy, Seizure focus, FDG-PET, VEM

Full Text:




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