18F-FDG PET/CT in pachygyria during evaluation for seizure disorder

Pachygyria or incomplete lissencephaly is a developmental condition due to abnormal migration of neurons. The association of seizures in this condition warrants investigation like electroencephalogram (EEG) and magnetic resonance imaging (MRI). 18F-flurodeoxyglucose positron emission topography computed topography (18F-FDG PET/CT) has a potential role in commenting of wide distribution of abnormal metabolism in affected brain parenchyma as well as hypermetabolic epileptogenic focus during ictal phase. Scan during interictal phase will give an idea of affected regions in brain in the form of hypometabolic areas. Although treatment is long-term antiepileptic drugs however if the epileptogenic foci are localized to same region then surgical interventions like hemispherectomies are the options. We present a case in which 18F-FDG PET/CT proved beneficial in pachygyria with seizure disorder.