Beyond FDG PET in Epilepsy: Radiotracers Targeting Neuroreceptors and Neural Proteins

Epilepsy, a prevalent neurological disorder worldwide, requires precise identification of the epileptogenic zone (EZ) to achieve optimal therapeutic outcomes, particularly in patients with drug-resistant epilepsy. Advanced neuroimaging plays a pivotal role in the presurgical evaluation of these patients. While [¹⁸F]fluorodeoxyglucose (FDG) remains the most widely utilized PET radiotracer in clinical practice, non-FDG radiotracers offer complementary molecular and neurochemical insights that extend beyond glucose metabolism. By targeting specific receptors, transporters, synaptic density, and neuroinflammatory processes, these tracers may improve the localization and biological characterization of the EZ. Although non-FDG PET radiotracers are still used predominantly in the research setting, ongoing advances in radiotracer development could further increase their clinical applicability in the evaluation of epilepsy. This review provides a comprehensive overview of currently available non-FDG PET radiotracers and summarizes their pathophysiological significance and promising clinical applications in epilepsy.