We compared the results of x-ray CT, magnetic resonance imaging (MRI), and positron emission tomography (PET) using 18F 2-deoxyglucose in 36 patients with partial seizures. Seventeen patients had localized epileptic discharges on surface EEG. MRI showed an abnormality in 9, CT in 4, and PET in 13 of 14 patients who had the test. Nineteen patients had nonlocalizing EEG discharges. MRI showed an abnormality in 11, CT in 10, and PET in 8 of 12. MRI is more sensitive than CT in detecting structural lesions underlying PET hypometabolism.
We studied the relationships between cerebral structure and function in 10 patients with complex partial seizures who had major cerebral lesions, including porencephalic cysts, tuberose sclerosis, agenesis of the corpus callosum, and cerebral hemiatrophy. Evaluation included computed tomography (CT) and magnetic resonance imaging (MRI) scanning, EEG, and positron emission tomography (PET) using [18F]-2-deoxyglucose. Surface EEG usually showed widespread, bilateral epileptiform discharges even if pathology was clearly restricted to one hemisphere. In several cases, interictal PET hypometabolism was more widespread than structural changes seen on CT and MRI, extending to involve the ipsilateral temporal lobe in patients with extratemporal lesions. This study shows that patterns of metabolic and electrophysiologic dysfunction may not be predicted by structural lesions in patients with partial seizure disorders.
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