The use of neuroimaging and its value in diagnosis were determined in a community based study of 613 children with newly diagnosed epilepsy referred to Yale University, New Haven, CT. Of the patients examined, 80% had imaging studies, 63% received an MRI, 32% a CT scan, and 16% had both. Idiopathic generalized epilepsies and other forms of epilepsy were evaluated with imaging studies in 50% and 87% of cases, respectively. Neuroimaging was positive for etiologically relevant abnormalities in 12.7% of cases. Of 14 patients whose clinical findings were otherwise completely normal, neuroimaging showed tuberous sclerosis in 4, tumors (2), arteriovenous abnormality (1), cavernous angioma (1), cerebral malformations (3), and other lesions (3). Seizures were partial in 13 (93%) of the 14 cases, and EEGs were focal in 12 (96%). 
COMMENT. Etiologically relevant cerebral abnormalities may be detected by imaging studies in a small but significant proportion of newly diagnosed epilepsies in children, despite an otherwise normal clinical presentation. Patients with neurologic deficits, partial seizures, or focal EEG abnormalities are especially at risk for positive imaging studies.