Positron Emission Tomography: Glucose Metabolism Studies in Temporal Lobe Epilepsy

Epilepsy poses unique problems and opportunities for cerebral imaging with positron emission tomography (PET). After reviewing PET methods in epilepsy applications, this chapter addresses the extensive applications of 2-[18F]fluoro-2-deoxyglucose (FDG) mapping of glucose metabolism in temporal lobe epilepsy (TLE). The widespread zone of interictal metabolic dysfunction is highly associated with sites of ictal onset and propagation in TLE. Interictal FDG PET is used in correlation with ictal electrophysiologic and structural magnetic resonance findings for the purposes of: 1) increasing certainty that the ictal onset zone has been accurately determined by noninvasive studies prior to therapeutic temporal lobe ablation, 2) optimizing selection of intracranial electrode placement sites for ictal monitoring, and 3) prognostication for epilepsy surgery with regard to seizure control.