Radionuclide brain scans in convulsive disorders

In a recent article, Tefft1 has stated that radioactive brain scans must be used to evaluate each child with a convulsive disorder, including those with a normal neurological examination and a normal or nonspecific electroencephalogram. He states that this should be done to rule out the presence of a low grade intracranial neoplasm or arteriovenous malformation. We would like to present three objections to this blanket policy. First, the yield would be extremely low. Follow up of children with epilepsy detected gliomas in 23 of 10,450 children (0.3%) in the study by Page, et al.2 and in 3 of 1,518 (0.2%) studied by Livingston.3