Interictal and postictal focal hypermetabolism on positron emission tomography

Decreased glucose utilization in the epileptogenic zone is typically observed interictally on positron emission tomography (PET), whereas ictal PET studies reveal complex patterns of increased and decreased metabolism. PET findings of 7 children, ages 2 months to 16 years, are described and demonstrate small focal regions of hypermetabolism in the absence of clinical or electrographic seizure during the 2-deoxy-2[ 18F]fluoro- d-glucose (FDG) uptake period. Magnetic resonance imaging scans were nonlocalizing in 5 of 7 children. In 4 children, seizures had not occurred for at least several hours prior to PET. Electroencephalography during PET disclosed active spike-and-wave activity on the side of interictal hypermetabolism in these 4 children. The remaining 3 children had seizures within 15 min prior to FDG injection and were considered postictal; their PET images revealed focal hypermetabolism. Results indicated the need for electroencephalographic monitoring during functional neuroimaging studies of all epileptic patients. The biochemical basis of interictal hypermetabolism is probably related to increased energy consumption by an active epileptogenic focus, whereas postictal hypermetabolism is likely due to energy expenditure for the restoration of resting membrane potentials and chemical homeostasis following an epileptic event.