Cognitive outcomes following epilepsy in infancy: A longitudinal community-based study.

OBJECTIVE: Onset of epilepsy before 2 years of age is associated with poor cognitive outcome; however, the natural course of the range of epilepsies that occur at this age is unknown. The aim of this prospective community-based study was to investigate the neuropsychological development of infants with newly diagnosed epilepsy longitudinally and to identify the clinical factors that predict long-term impairment. METHODS: Sixty-six infants <24 months of age were enrolled in the baseline phase of this study; 40 were seen again at 1-year follow-up and 40 at 3-year follow-up. Children underwent a neurological and neuropsychological assessment at each time point. RESULTS: More than 55% of children demonstrated impaired cognitive functioning at each assessment, with a similar percentage showing impaired memory and attention at 3-year follow-up. Cognitive scores obtained at each time point were correlated. More than 20 seizures/seizure clusters prior to assessment and an abnormal neurologic examination predicted poor cognitive functioning at baseline, whereas continuing seizures and baseline cognitive score predicted 3-year intelligence quotient (IQ)/cognitive score. SIGNIFICANCE: These findings demonstrate the following: (1) infants who are performing poorly at baseline continue to display impaired development at follow-up, (2) these children are delayed across a range of neuropsychological functions, and (3) a high number of seizures close to initial diagnosis and continuing seizures at follow-up independently predict cognitive impairment. These findings help to identify those infants with new-onset epilepsy who are most at risk for poor developmental outcome and suggest that multimodal interventions should be instituted early in the course of the disorder to improve outcomes.

"I look forward. I feel insecure but I am ok with it". The experience of young HIV+ people attending transition preparation events: a qualitative investigation.

Transition programmes which prepare young people with HIV to manage the medical, social and psychological consequences of the condition can provide clinical benefits for both young people and their families. The London-based Looking Forward Project (LFP) is embedded within a National Health Service HIV family clinic. The project uses a group work approach and aims to equip HIV+ young people over the age of 12 years who know their status with the emotional, psychological and behavioural skills necessary to face the challenges of living with HIV. This small scale qualitative study investigated the experience of attendance, explored factors which facilitated participation in the groups and investigated the impact on their lives as a result of participation. Participants reported that the LFP events were educational but different to school-like activities, being with other young people reduced isolation and that receiving a voucher was an incentive to attend. Participation was facilitated through family support. Attendance at the LFP facilitated a positive attitude towards medication and hope for the future.