30 patients with pharmacoresistant epilepsy underwent scalp Video-EEG monitoring (Neuron-Spectr 4P, Neurosoft, Russia) and  18F-FDG PET/MRI of the brain (Signa PET/MRI, GE Healthcare, USA). Long-term-video-EEG monitoring included analysis of bioelectric brain activity during active and passive wakefulness with standard functional tests (hyperventilation, photostimulation). The standardized patient preparation for the PET was performed according to the European guideline (2009). 25 min list-mode 3D PET acquisition was performed with direct attenuation correction using MRI Dixon sequences. Specialized epilepsy MRI scanning protocol was performed synchronously with PET and  included 3D volumetric MRRAGE and FLAIR, axial and coronal T2-weighted images with 2mm slice thickness, DWI and SWI impulse sequences.

   PET/MRI images were first analyzed visually structural findings were compared with areas of 18F-FDG hypometabolism, then quantitative PET parameters (SUVmax, SUVmean, SUVpeak, asymmetry index) were estimated and repeated analysis of structural MRI brain changes in the dedicated areas was done.

   All of the cases were discussed on the multidisciplinary team meeting including epileptologists, neurophysiologists, neuroradiologists and neurosurgeons, where further treatment strategy was formed: surgical resection of the epileptogenic lesion (10patients), performig of invasive SEEG (9 patients), continuation of the anticonvulsant therapy (10 patients). In 1 patient clinical and diagnostic findings were qualified as non-epileptic paroxysmal state.