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Glioblastomas in children usually occur in the brainstem and are often untreatable and associated with an extremely poor prognosis. Such tumours may however occur in supratentorial locations more typically associated with adult gliomas, where the outcome is more variable, but still poor. This report describes the case of a boy with fragile X who also developed an inoperable midbrain glioblastoma, but who has survived 8 years after diagnosis.

Hefin was born in 1929 in Bethesda, North Wales, a small slate quarrying town. His early pathological training in Cardiff led to a lifelong interest in lung pathology, and he had a particular interest in asbestos-related mesothelioma. After his consultant appointment, he carried out a postmortem study of asbestos-related …

Editor—In their editorial on the misdiagnosis of epilepsy Chadwick and Smith seem to have missed the point.1 The diagnosis of epilepsy is often difficult and mistakes are often made (by specialists and non-specialists), so an improvement in epilepsy services is imperative. As the editorial says, there are only a derisory 62 paediatric neurologists in the United Kingdom; even at the maximal rate of recruitment to this specialty it will be at least 15 years before an appreciable proportion of children with epilepsy have an opportunity of meeting such a specialist, let alone being treated by him or her on a continuing basis. The most important improvement in epilepsy services will therefore come from better training for general paediatricians and physicians, together with more effective ways in which they can share their difficult cases with specialist neurologists, who are usually based in tertiary centres. In addition, epilepsy support services provided by trusts, including neurophysiology, need to be radically improved. None of this was available to Dr Andrew Holton in Leicester, whom Chadwick and Smith mention in the editorial. In the review into his work by the British Paediatric Neurology Association he was noted to be a hard working and conscientious doctor.2 It recommended that he should be returned to his post after six months of retraining. He was no doubt upset to be failing in the management of several of his patients but was without sufficient training, was overworked, waited far too long for electroencephalography to be performed, and was isolated without having any specialist support available at regional level. Like many patients, Dr Holton has become a victim of the deficiencies in epilepsy care in the United Kingdom for children and adults. We certainly need more specialists, but we also need better training for generalists and better support for us all.

EDITOR,—We read Jonathan Shapiro's editorial on global commissioning by general practitioners with some concern.1 While we favour increasing the involvement of general practitioners in the commissioning of health services, we are concerned about the possible impact of extending the scope of general practice fundholding on the provision of specialist rehabilitation services for adults and children with complex disabilities. Some aspects …

EDITOR,--Minerva's comment on the future of Graves Medical Audiovisual Library is ill informed.1 In 1993 Graves Educational Resources transferred its audiovisual distribution services to Concord Video and Film Council, based in Ipswich, …