Objective To evaluate the role of vedio-electroencehpalography ( VEEG) monitoring in inter-preting the cortical and subcortical hypermetabolic foci in interictal 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography ( PET) imaging in patients with epilepsy .Methods From January 2008 to March 2014 in Peking Union Medical College Hospital , 3 epileptic patients whose first 18 F-FDG PET scan showed unexplained hypermetabolic foci without seizure underwent repeated 18 F-FDG PET scan in the interictal status proved by VEEG monitoring after discharge suppression by intravenous diazepam .Then compared the first and second scan images.Results For case 1 who suffered from epilepsy originating from medial right temporal lobe , unexplain-able hypermetabolic foci in right frontal lobe , basal ganglia , thalamus, and left cerebellum were present in in-terictal 18 F-FDG PET scan.After suppressing cortical discharge under VEEG monitoring , the second 18 F-FDG PET scan showed that the cortical and subcortical hypermetabolism disappeared , indicating that the hypermetabol-ic foci in the first scan was due to the subclinical discharge in a potential extratemporal seizure origin site , and the existence of efferent network activity from that origin site to ipsilateral basal ganglia and thalamus and contra -lateral cerebellum .The original clinical decision of simple anterior temporal lobectomy was altered based on the findings.For case 2, hypermtabolism was present in a large part of right frontal lobe , which persisted after sup-pressing discharge under VEEG monitoring .While the hypermetabolic foci in ipsilateral basal ganglia and contra-lateral cerebellum became less obvious in the second 18F-FDG PET scan, proving that the original lesion (inflam-mation) with hypermetabolism existed in the cortex , and the hypermetabolic foci in basal ganglia and thalamus were due to secondary functional change .Case 3 suffered from temporal lobe epilepsy with origin undeterminable with clinical information , electroencephalogram , or magnetic resonance imaging .Hypermtabolic left hippocampus was shown in both the first 18 F-FDG PET scan and the second PET scan under definite interictal status with VEEG monitoring , suggested the existence of a hypermetabolic lesion ( tumor ) , facilitating the clinical decision on surgical site .Conclusions For the epileptic patients with hypermetabolic foci in 18 F-FDG PET without sei-zure, repeated 18 F-FDG PET imaging in definite interictal status under VEEG monitoring can help interpret the etiology and define the extent of lesions for better clinical decision-making .%目的：探讨癫痫患者无临床发作情况下18F-氟脱氧葡萄糖（18F-fluorodeoxyglucose，18F-FDG）正电子发射计算机断层（positron emission tomography， PET）脑显像呈现高代谢时脑电监测的应用价值。方法对北京协和医院2008年1月至2014年3月共3例无临床发作的间期情况下18 F-FDG PET脑显像呈现皮层或皮层下高代谢的癫痫患者，静脉注射安定抑制皮层放电，在脑电监测确认无皮层异常放电时复查18 F-FDG PET脑显像，并对比两次显像结果。结果病例1为颞叶癫痫患者，在无临床发作时18 F-FDG PET显像除发现右颞低代谢外，右额部分皮层及同侧基底节、丘脑及左侧小脑局灶代谢增高。脑电监测下抑制皮层放电后的18 F-FDG PET显像示原额叶皮层及同侧基底节、丘脑、对侧小脑高代谢灶消失。表明该患者上述高代谢灶为颞叶外皮层潜在致痫灶亚临床放电所致，同时证实了致痫灶与同侧基底节丘脑、对侧小脑之间的神经传导。此例改变了先前单纯前颞叶切除术的临床决策。病例2的间期18 F-FDG PET显像发现右侧大片额叶皮层高代谢，脑电监测下抑制临床下放电后，原皮层高代谢仍存在，原同侧基底节、对侧小脑的高代谢已不明显，证实皮层存在高代谢的基础病变（炎症），而基底节丘脑为继发功能改变，确定了病变性质及范围。病例3为颞叶癫痫患者，临床及脑电无法确定癫痫起源部位，磁共振成像未见明显异常。18 F-FDG PET显像在无临床发作的情况下左侧海马区呈高代谢，脑电监测下在明确的间期状态复查18 F-FDG PET脑显像，左侧海马区仍为高代谢。提示该部位存在基础病变（肿瘤），帮助临床确定手术部位。结论癫痫患者无临床发作情况下18 F-FDG PET显像呈现高代谢图像时，在脑电监测下确认绝对的间期状态时复查18 F-FDG PET显像，有助于分析高代谢的病因及明确病变范围，帮助作出临床决策。
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