EANM practice guidelines for an appropriate use of PET and SPECT for patients with epilepsy

Tatjana Traub-Weidinger, Javier Arbizu, Henryk Barthel, Ronald Boellaard, Lise Borgwardt, Matthias Brendel, Diego Cecchin, Francine Chassoux, Francesco Fraioli, Valentina Garibotto, Eric Guedj, Alexander Hammers, Ian Law, Silvia Morbelli, Nelleke Tolboom, Donatienne Van Weehaeghe, Antoine Verger, Wim Van Paesschen, Tim J von Oertzen, Pietro ZucchettaFranck Semah*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Epilepsy is one of the most frequent neurological conditions with an estimated prevalence of more than 50 million people worldwide and an annual incidence of two million. Although pharmacotherapy with anti-seizure medication (ASM) is the treatment of choice, ~30% of patients with epilepsy do not respond to ASM and become drug resistant. Focal epilepsy is the most frequent form of epilepsy. In patients with drug-resistant focal epilepsy, epilepsy surgery is a treatment option depending on the localisation of the seizure focus for seizure relief or seizure freedom with consecutive improvement in quality of life. Beside examinations such as scalp video/electroencephalography (EEG) telemetry, structural, and functional magnetic resonance imaging (MRI), which are primary standard tools for the diagnostic work-up and therapy management of epilepsy patients, molecular neuroimaging using different radiopharmaceuticals with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) influences and impacts on therapy decisions. To date, there are no literature-based praxis recommendations for the use of Nuclear Medicine (NM) imaging procedures in epilepsy. The aims of these guidelines are to assist in understanding the role and challenges of radiotracer imaging for epilepsy; to provide practical information for performing different molecular imaging procedures for epilepsy; and to provide an algorithm for selecting the most appropriate imaging procedures in specific clinical situations based on current literature. These guidelines are written and authorized by the European Association of Nuclear Medicine (EANM) to promote optimal epilepsy imaging, especially in the presurgical setting in children, adolescents, and adults with focal epilepsy. They will assist NM healthcare professionals and also specialists such as Neurologists, Neurophysiologists, Neurosurgeons, Psychiatrists, Psychologists, and others involved in epilepsy management in the detection and interpretation of epileptic seizure onset zone (SOZ) for further treatment decision. The information provided should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals and imaging modalities.

Original languageEnglish
Pages (from-to)1891-1908
Number of pages18
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number7
Publication statusPublished - Jun 2024


  • Humans
  • Epilepsy/diagnostic imaging
  • Tomography, Emission-Computed, Single-Photon
  • Positron-Emission Tomography/methods
  • Nuclear Medicine
  • Europe


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