SPECT studies for rCBF imaging in clinical epilepsy are reviewed divided into interictal, ictal and postictal SPECT studies in partial and generalized epilepsies, as compared with the corresponding PET studies, and at times referring to SPECT studies in experimental models of epilepsy. All of the interictal, ictal and postictal SPECT scans in partial epilepsy are useful for the regional determination of epileptic foci, in view of the high appearance rates of focal abnormalities on these SPECT scans and good correlation with epileptic EEG foci. Mechanisms underlying the focal abnormality on interictal SPECT scans (i.e., focal hypoperfusion) image are complicative, and therefore, studies concerning the underlying mechanisms are reviewed with regard to correlations of the SPECT abnormality with the following various clinical factors: focal organic lesions on X-ray CT or MRI scans, frequencies of clinical seizures or interictal seizure discharges on EEGs, background EEG activity, propagation of epileptic activity, antiepileptic drugs, and cognitive functions. Further, new neurochemical SPECT studies using 123I-Iomazenil for benzodiazepine receptor imaging in clinical epilepsy are reviewed and compared with earlier SPECT studies for rCBF imaging with regard to their utility in regional determination of epileptic foci. In addition, the few SPECT or PET studies available on epileptic psychosis are reviewed.