A major challenge in human pre-surgical epileptic patient evaluation is the correct identification of the seizure onset area, especially in MR-negative patients. This study assessed 20 patients with refractory focal epilepsy using PET/MR and PET/CT with standardized uptake value ratio (SUVr) and cerebral blood flow (CBF) maps being calculated for PET/CT-PET/MR and ASL, respectively. Results showed high agreement between ASL and 18F-FDG PET/MR with hypometabolism and hypoperfusion in the same hemisphere in 18/20 patients, while the remaining were normal. 18F-FDG PET/CT-PET/MR showed high agreement, especially when zAI was considered. The simultaneous metabolism-perfusion acquisition provides excellent concordance on focus lateralisation and good concordance on localisation, determining useful complementary information.