Positron emission tomography and single photon emission computed tomography in epilepsy care

Semin Nucl Med. 2003 Apr;33(2):88-104. doi: 10.1053/snuc.2003.127301.


Radiopharmaceutical brain imaging is clinically applied in planning resective epilepsy surgery. Cerebral sites of seizure generation-propagation are highly associated with regions of hyperperfusion during seizures, and with glucose hypometabolism interictally. For surgical planning in epilepsy, the functional imaging modalities currently established are ictal single photon emission computed tomography (SPECT) with [(99m)Tc]technetium-hexamethylpropyleneamine oxime (HMPAO) or with [(99m)Tc]technetium-ethylene cysteine dimer (ECD), and interictal positron emission tomography (PET) with 2-[(18)F]fluoro-2-deoxyglucose (FDG). Ictal SPECT and interictal FDG PET can be used in presurgical epilepsy evaluations to reliably: (1) determine the side of anterior temporal lobectomy, and in children the area of multilobar resection, without intracranial electroencephalographic recording of seizures; (2) select high-probability sites of intracranial electrode placement for recording ictal onsets; and, (3) determine the prognosis for complete seizure control following anterior temporal lobe resection. Coregistration of a patient's structural (magnetic resonance) and functional images, and statistical comparison of a patient's data with a normal data set, can increase the sensitivity and specificity of these SPECT and PET applications to the presurgical evaluation.

Publication types

  • Review

MeSH terms

  • Brain / diagnostic imaging*
  • Brain / metabolism
  • Cysteine / analogs & derivatives*
  • Cysteine / pharmacokinetics
  • Epilepsy / diagnostic imaging*
  • Epilepsy / metabolism
  • Epilepsy, Absence / diagnostic imaging
  • Epilepsy, Absence / metabolism
  • Epilepsy, Generalized / diagnostic imaging
  • Epilepsy, Generalized / metabolism
  • Epilepsy, Temporal Lobe / diagnostic imaging
  • Epilepsy, Temporal Lobe / metabolism
  • Fluorodeoxyglucose F18 / pharmacokinetics
  • Humans
  • Organotechnetium Compounds / pharmacokinetics
  • Predictive Value of Tests
  • Preoperative Care / methods
  • Radiopharmaceuticals* / pharmacokinetics
  • Technetium Tc 99m Exametazime / pharmacokinetics
  • Tomography, Emission-Computed / methods*
  • Tomography, Emission-Computed, Single-Photon / methods*


  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Technetium Tc 99m Exametazime
  • technetium Tc 99m bicisate
  • Cysteine