Positron Emission Tomography: Brain Glucose Metabolism in Pediatric Epilepsy Syndromes

The advent of positron emission tomography (PET) scanning using 2-deoxy-2-[18F] fluoro-D-glucose (FDG) has significantly improved our understanding of the pathomechanisms of different pediatric epilepsy syndromes. Furthermore, it has dramatically altered our management approach of certain intractable epilepsy syndromes, such as infantile spasms. Glucose metabolism PET scanning has assumed an important role not only in the identification and localization of epileptogenic cortex, but also in assessing the functional integrity of the entire cerebral hemisphere, thereby providing useful diagnostic and prognostic information, including the suggestion of underlying neurometabolic or neurogenetic disorders which may preclude epilepsy surgery. In certain progressive epilepsy syndromes like Rasmussen encephalitis and Sturge-Weber syndrome, PET scanning also may be used to assess disease progression. In this chapter, we discuss the relevant role of brain glucose metabolism PET in understanding thepathogenesis of pediatric epilepsy syndromes with regard to diagnosis and treatment.