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Summary   Objective  Interictal [18F]fluorodeoxyglucose–positron emission tomography ( FDG ‐ PET ) is used in the presurgical evaluation of patients with drug‐resistant focal epilepsy. We aimed at clarifying its relationships with ictal high‐frequency oscillations ( iHFO s) shown to be a relevant marker of the seizure‐onset zone.    Methods  We studied the correlation between  FDG ‐ PET  and epileptogenicity maps in an unselected series of 37 successive patients having been explored with stereo‐electroencephalography (SEEG).    Results  At the group level, we found a significant correlation between  iHFO s and  FDG ‐ PET  interictal hypometabolism only in cases of temporal lobe epilepsy. This correlation was found with  HFO s, and the same comparison between  FDG ‐ PET  and ictal  SEEG  power of lower frequencies during the same epochs did not show the same significance.    Significance  This finding suggests that interictal  FDG ‐ PET  and ictal  HFO s may share common underlying pathophysiologic mechanisms of ictogenesis in temporal lobe epilepsy, and combining both features may help to identify the seizure‐onset zone.

Correlation of FDG ‐ PET hypometabolism and SEEG epileptogenicity mapping in patients with drug‐resistant focal epilepsy