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Updated: Jun 6, 2026
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Published on: September 20, 2024
18F-FDG PET reveals frontotemporal dysfunction in children with fever-induced refractory epileptic encephalopathy
Michel Mazzuca1, Isabelle Jambaque, Lucie Hertz-Pannier
1APHP, Neuropediatric Department, Hospital Necker-Enfants Malades, and Inserm, U663-University Paris Descartes, Paris, France.
Unlabelled:
Fever-induced refractory epileptic encephalopathy in school-age children (FIRES) is a recently described epileptic entity whose etiology remains unknown. Brain abnormalities shown by MRI are usually limited to mesial-temporal structures and do not account for the catastrophic neuropsychologic findings.
Methods:
We conducted FIRES studies in 8 patients, aged 6-13 y, using 18F-FDG PET to disclose eventual neocortical dysfunction. Voxel-based analyses of cerebral glucose metabolism were performed using statistical parametric mapping and an age-matched control group.
Results:
Group analysis revealed a widespread interictal hypometabolic network including the temporoparietal and orbitofrontal cortices bilaterally. The individual analyses in patients identified hypometabolic areas corresponding to the predominant electroencephalograph foci and neuropsychologic deficits involving language, behavior, and memory.
Conclusion:
Despite clinical heterogeneity, 18F-FDG PET reveals a common network dysfunction in patients with sequelae due to fever-induced refractory epileptic encephalopathy.
Insights
Fever-induced refractory epileptic encephalopathy in school-age children (FIRES) is a rare epilepsy. 18F-FDG PET scans reveal widespread brain dysfunction, explaining severe cognitive and behavioral issues in affected children.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Epileptology
Background:
- Fever-induced refractory epileptic encephalopathy in school-age children (FIRES) is a distinct epileptic condition with unknown causes.
- Standard MRI often shows limited brain abnormalities that do not correlate with severe neuropsychological deficits.
Purpose of the Study:
- To investigate neocortical dysfunction in FIRES using 18F-FDG PET.
- To identify common patterns of brain metabolism abnormalities in FIRES patients.
Main Methods:
- Eight school-aged children (6-13 years) with FIRES underwent 18F-FDG PET scans.
- Voxel-based analysis of cerebral glucose metabolism was performed using statistical parametric mapping, comparing patients to an age-matched control group.
Main Results:
- Group analysis identified a widespread hypometabolic network in the temporoparietal and orbitofrontal cortices.
- Individual analyses correlated hypometabolic areas with EEG foci and deficits in language, memory, and behavior.
Conclusions:
- 18F-FDG PET imaging reveals a consistent network dysfunction in FIRES patients, despite clinical variability.
- This brain network dysfunction likely underlies the significant neurological sequelae observed in FIRES.
