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FDG-PET in MRI-Negative Epilepsy — SCE Neurology MCQ

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HardClinical NeurophysiologyFDG-PET in MRI-Negative EpilepsySCE Neurology

A 55-year-old man presents with a 2-year history of episodes of altered awareness, staring, and repetitive hand movements lasting 2–3 minutes. MRI brain with standard epilepsy protocol is normal. His neurologist orders an FDG-PET scan. PET shows focal hypometabolism in the right temporal lobe. What is the clinical significance of this finding?

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Correct answer: E — It identifies the likely seizure onset zone in MRI-negative temporal lobe epilepsy, supporting surgical candidacy

The best answer is “It identifies the likely seizure onset zone in MRI-negative temporal lobe epilepsy, supporting surgical candidacy”. NICE bases epilepsy diagnosis and treatment on seizure type, syndrome, recurrence risk, comorbidity, pregnancy potential and medicine harms; typical provoked seizures are managed by correcting the provoking cause. The alternatives “It confirms Alzheimer disease, within the relevant UK pathway, after excluding important mimics”, “It indicates a brain tumour, after excluding important mimics, after specialist assessment, when the phenotype supports it”, “It is a normal ageing finding, after specialist assessment, when the phenotype supports it”, “It confirms vascular dementia, when the phenotype supports it, within the relevant UK pathway” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG217 epilepsy recommendations: https://www.nice.org.uk/guidance/ng217/chapter/Recommendations