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    R E P O R T
    on the Activities of the Polish National Epilepsy Centre for Pregnant Women 2003.


    Medical Activities
         One hundred and twenty women with epilepsy were referred to the OCPK register in 2003. At the time of referral 69 patients (57%) were in monotherapy (i.e., were taking 1 antiepileptic drug), 26 (22%) were in polytherapy (4 of them were taking more than 2 AEDs) (cf. Table 1) and 25 (21%) were not taking any medication.
    The distribution of AEDs in the monotherapy group (n=69) was as follows:
    LTG - 23
    CBZ - 20
    VPA - 16
    OCBZ - 9
    TPM - 1

    The distribution of AEDs in the polytherapy group (n=26) was as follows:

    Table 1
     CBZ + LTG - 6 VPA+ ESM - 1
     VPA +LTG - 5 LEV +PB - 1
     CBZ + VPA - 2 LTG + CBZ + VPA - 1
     TPM +CBZ - 3 VGB + CBZ +VPA+CLZ - 1
     LTG + OCBZ - 2 GBP + CBZ + CLZ - 1
     CBZ + CLZ - 1 PHT +CBZ +PB - 1
     CBZ + TGB - 1  -


    Table 2
    AEDs
    Total
    Monotherapy
    Polytherapy
    Carbamazepine (CBZ)   37
    20
    17
    Lamotrygine (LTG)   37
    23
    14
    Valproic acid (VPA)   26
    16
    10
    Oxcarbazepine (OCBZ)   11
    9
    2

         In monotherapy, conventional AEDs (CBZ and VPA) and new generation AEDs (OCBZ, LTG, TPM) were administered in similar proportions (52% and 48% respectively).

         Fifty-two patients ended their pregnancy in 2003. In this group 43 (83%) gave birth to healthy babies. Two pregnancies ended in miscarriages: one in 19 hbd (LTG+VPA) and one in 12 hbd (CBZ+VPA).
         Four (7.6%) gave birth to babies with congenital anomalies: 1 dilated renal calyx (CBZ), 2 venticular septal defects (VPA in both cases); 1 additional finger (CBZ+LTG). One baby died (no anomalies were found despite the polytherapy) due to chronic hypoxia resulting from the mother's status epilepticus.

         Thirty-nine (75%) of the 52 patients were in monotherapy at the time of delivery, 11 (21.2%) were in polytherapy including 3 who were taking more than two AEDs (Table 3) and 2 (3.8%) were not taking any medication.

    Table 3
     Monoteraphy: n = 39: Polytherapy: n = 11:
     CBZ - 14 VPA +LTG - 3
     VPA - 9 CBZ + LTG - 2
     LTG - 9 VPA + CBZ - 1
     OCBZ - 7 TGB+LTG - 1
      CBZ + TGB - 1
      DPH+TGB+LTG - 1
      CBZ + VGB+CLZ - 1
      GBP + CBZ + CLZ - 1


    Table 4
    AEDs Total Monotherapy (n=39) Polytherapy (n=11)
    Carbamazepine (CBZ)
    22
    14
    8
    Lamotrygine (LTG)
    16
    9
    7
    Valproic acid (VPA)
    13
    9
    4
    Oxcarbazepine (OCBZ)
    7
    7
    0


    In monotherapy, conventional AEDs (CBZ and VPA) and new generation AEDs (OCBZ, LTG) were administered in similar proportions (59% and 41% respectively).

    Conclusions

    The primary goal of OCPK activity


    a. Raising the awareness of epileptic patients and society in general that epileptic women may have families and give birth to healthy children;

    b. Dissemination of information among patients, society in general and medical professionals concerning pregnancy risk factors in epileptic women;

    c. Making every effort to ensure that epileptic women who are pregnant or planning to have children have interdisciplinary, highly professional care countrywide.


    The following actions are being taken towards these goals:

    a. Information about OCPK and its activities and medical articles on the Centre's goals; relevant information has been published in EPI (no. 2002/4 was devoted to motherhood and epilepsy), Epileptologia, 2002, 10: 391-396 and reports from the annual symposia on epilepsy and pregnancy organised by the Foundation of Epileptology, also published in Epileptologia;

    b. Organisation of training conferences for medical professionals working in local communities and wanting to participate in OCPK activities.

    Suggestions for future OCPK activities

    The number of pregnant epileptic women referred to OCPK could be increased by:

    a. Improvement of the communications systems between the Foundation and the referring doctor submitting the first referral form. A member of the Foundation Staff will keep in touch with the doctor and remind him/her about the deadlines for submitting the next forms or - in special cases - will get in touch with the patient herself with her doctor's permission.

    b. Organisation of national training conferences for neurologists, neonatologists, gynaecologists and obstetricians.

    c. Promoting activities during the Epilepsy and Pregnancy annual symposia.

    d. Getting in touch with new regional collaborators in order to increase their numbers.

    e. Boosting doctors' motivation by signing financial agreements between them and the Foundation. The sum of 120 PLN for filling in four questionnaires during the patient's pregnancy and delivery seems reasonable. Terms and conditions: 50% will be paid after submission of the first questionnaire and the remaining 50% after completion of the one-year observation (submission of the remaining questionnaires or OCPK's telephone contact with the patient). The costs of these Foundation-Doctor contracts will be covered in 2004 by the Foundation's surplus funds for consultations.

    f. Streamlining of the process of entering data from the forms to the EURAP program.


    Professor Jerzy Majkowski, M. D., Ph. D.

    President of the Foundation
    Executive Board