Objective-To evaluate social maturation and psychiatric morbidity in young adults treated for epilepsy during their childhood. Methods-Eighty one young adults (43 women, 38 men, mean age 22-3 years) with epilepsy during their childhood were interviewed about their social development and psychiatric symptoms. The results were compared with those from 211 randomly selected controls (106 women, 105 men, mean age 23-2 years). Results-Compared with the controls the patients had more often not succeeded in passing the normal comprehensive school (20% v 2%) or had left school at the secondary level (53% v 46%) and remained without any vocational education (27% v 11 %). There was no significant difference in the employment status of those with work between the patients and the controls. The patients were significantly more often labelled with poor social maturation and dependent lifestyle factors such as living with their parents. However, risk analysis showed that neither the disease itself nor antiepileptic medication were significant predisposing factors for poor social adjustment but low or borderline mental capacity or learning disabilities relating to epilepsy were. Psychiatric morbidity was similar in both groups. Conclusions-The social handicap found in a certain group of young adults with epilepsy during childhood is largely associated with neurological and cognitive impairments other than epilepsy itself. With the present mode of treatment epilepsy itself does not seem to disturb adolescent social and psychological development.

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We reviewed the previous medical history and the social status of all patients of Oulu University Central Hospital who had had in the age range 16-26 years shunted hydrocephalus (HC) during childhood. Of 42 patients selected 7 had died and another 5 had been institutionalized for severe mental handicap. Shunts had been changed a total of 103 times in 29 patients still living. The most common reason for a reoperation was blockage. Half of the patients re-examined showed neurological abnormalities or epilepsy. Both the verbal and the nonverbal IQ of the patients remained weak to average. Even though the patients' medical prognosis was fair, their social maturation did not keep up with their physical abilities. One-third were receiving or had received vocational training, but only a few were working. Up to one-quarter of the patients with shunted HC were at home without any meaningful work activities.

The authors evaluated whether alfentanil could be given before treatment procedures in critically ill mechanically ventilated neonates without adverse effects. Alfentanil (mean dose 11.7 micrograms/kg, range 9-15) was given intravenously to 20 mechanically ventilated critically ill newborn infants (mean birth weight 2510 g, range 1490-3990) during the first 3 days of life before treatment procedures. Heart rate, arterial blood pressure, transcutaneous partial pressure of O2, respiratory rate, and general activity were observed continuously from 10 min before the administration of alfentanil until 1 h after it. Plasma alfentanil concentrations were measured in 15 subjects. The pharmacokinetics of alfentanil varied greatly among the subjects. The hemodynamic changes were not clinically significant, and the most important side effect was muscle rigidity. Nine infants had mild or moderate rigidity, which had little or no effect on ventilation. Four infants had severe rigidity and jerking comparable to convulsive activity, transiently impairing ventilation and oxygenation for approximately 5-10 min. Increased inspired oxygen and increased pressure by manual ventilation were needed to prevent hypoxemia. Electroencephalographic recordings for three infants during alfentanil administration showed no evidence of increased seizure activity. We conclude that alfentanil should not be used for newborn infants without simultaneous muscle relaxation because of the danger of rigidity.