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Background: Parents of children with epilepsy have been shown to have higher rates of depression, anxiety and stress in comparison to parents of children without epilepsy due to the impact of caring for a child with a chronic condition. A systematic review of existing literature aimed to identify qualitative research that examined parents' experiences of caring for their children with epilepsy. Methods: The systematic review explored the experiences that parents have in caring for their child with epilepsy. A search of electronic databases for qualitative literature was completed. The quality of all eligible articles papers was assessed, and findings from studies were synthesised. Results: Twelve studies met inclusion criteria for the review; findings suggest that parents need time to process their child's diagnosis of epilepsy; they cope with this in differing ways and are motivated to learn how to adapt and cope with parenting their child with epilepsy. Conclusions: Parents of children with epilepsy may experience symptoms of stress, this may motivate them to learn how best to care for their child. Empirical Paper Abstract Background: Parents' experiences of being told about sudden unexpected death in epilepsy (SUDEP) may be particularly challenging to cope with. As little is known about how mothers understand and make sense of SUDEP, a qualitative research project aimed to explore mothers' experiences. It was hoped this would be helpful for clinicians to understand in order to assist them in providing information to parents in a way that minimises distress. Methods: The empirical article explored mother's experiences of being told about SUDEP and the subsequent impact of this for 11 mothers of children with epilepsy. Interpretative Phenomenological Analysis methodology was utilised, with themes derived from interpretation of interview transcripts, in order to describe the experiences of the participants. Results: Within the empirical study, five themes emerged. The way in which mothers found out about SUDEP seemed to have a link to their perception of risk and how they subsequently managed feelings of uncertainty and the psychological impact of knowing about SUDEP. Mothers' recommendations to clinicians included when, how and what to tell other parents, and were based on their own helpful and unhelpful experiences of being informed about SUDEP. Conclusions: In being told about SUDEP, mothers may struggle to make sense of it and this can be associated with an increase in anxiety. However, clinicians can reduce potential distress by carefully timing when and how they tell parents, and by making sure information is clear and relevant for the child in question.

Background: It is often considered that, following paediatric acquired brain injury (pABI) and epilepsy, higher-level cognitive deficits, such as prospective memory (PM), are impaired and may only become apparent over time when these abilities are expected to develop and mature in a typically developing child. Interventions supporting PM have the potential to increase independence and enhance social participation. Despite research indicating PM difficulties in children and adolescents with pABI and epilepsy, and also in children with PM difficulties with unknown aetiology, currently, there is a limited evidence-base for interventions, although previous research has attempted to address this following pABI (Rous, 2011). Objective: The objective of this empirical paper was to build upon the work of Rous (2011) and optimise the effectiveness of brief metacognitive 'Remembering Goals' Training (RGT) and external content-free cueing (in the form of 'STOP' text messages) on PM task performance and the achievement of real-life goals. Method: The research employed a single-case series design with a randomised, alternating treatment (Barlow & Hayes, 1979). Eight participants (aged 10-15 years) completed the study. Three participants had an ABI, two participants had epilepsy, and three participants experienced PM difficulties with unknown aetiology. The PM task required participants to send three text messages at set times and to complete three real-life goals each working day for a four-week period. After a baseline period, participants completed brief RGT via Skype twice during the study (once following baseline, and again half way through the study). The brief RGT facilitated metacognitive skills and participants learnt to associate texts reading 'STOP' with mentally reviewing their goals and tasks for that day. Six 'STOP' text messages (cues) were sent at random times on half of the days of the intervention. The number and accuracy of texts messages, and the achievement of real-life goals, were compared across cued and un-cued days to evaluate the efficacy of the intervention for each participant. Results: Five participants demonstrated improved PM text message performance and seven participants demonstrated improved performance in real-life goals. Most of the participants reported positive gains in self-reported PM abilities, and most parents of children with acquired neurological conditions reported reduced levels of family stress and burden following the intervention. Conclusions: This research offers some evidence in support of the efficacy of content-free cueing and RGT for facilitating PM abilities. The majority of participants engaged in more frequent and accurate PM tasks and, most importantly, achieved more of their real-life goals as a result of the intervention.

Research has demonstrated that prenatal exposure to antiepileptic drugs is associated with an increased risk of physical malformations. The potential risk such exposure conveys to the developing brain and therefore the later cognitive functioning of the child is now the focus of both national and international research. This thesis investigated the relationship between prenatal exposure to antiepileptic drugs and child cognitive functioning. This investigation was undertaken in three phases: a systematic review of the published literature; an original research piece investigating prenatal exposure to sodium valproate and levetiracetam and finally a critical review of the research undertaken as part of this thesis and in the wider published literature. The systematic review identified 30 studies which had investigated the cognitive abilities of children with a history of prenatal exposure to antiepileptic drugs. Methodological quality of the studies was considered against the criteria of the Newcastle Ottawa Scale. Differential findings were noted across the antiepileptic drug types, with the largest number of studies documenting increased risks associated with prenatal exposure to sodium valproate. A lack of high quality research across all antiepileptic drugs, and in particular the more recently licensed antiepileptic drugs is highlighted. In the research paper presented here children aged between five and nine years of age exposed to either levetiracetam (n=37), sodium valproate (n=40) or who were born to women with epilepsy but did not require medication (n=43) were recruited from throughout the UK. Demographic and health information was collected from prospective records and supplemented with maternal interview. Formal standardised neuropsychological assessments were undertaken to inform on the child's current level of intellectual, memory, language, attentional and executive functioning. Following adjustment for variables likely to influence child cognitive ability, prenatal exposure to sodium valproate was found to be associated with poorer intellectual and language functioning in a dose dependent manner. When stratified by dose, 57.9% of children exposed to doses of sodium valproate above 800mg daily scored below the average range for their global intellectual ability. Prenatal exposure to levetiracetam was not found to be associated with poorer cognitive functioning. The critical review highlighted a number of methodological strengths of this research, despite time and resource implications. However, consideration should be given to the retrospective nature of this cohort and the potential for recruitment bias. This thesis concludes that women who require continuation of their treatment during pregnancy to control their seizures should be counselled regarding the risks and the benefits of their treatment to allow them to make informed decisions.