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    The Training Centre for Epilepsy and Other Paroxysmal Disorders

         One of the Foundation of Epileptology's statutory goals is education of the medical and non-medical communities. To meet this objective the Foundation has opened its own Training Centre for Epilepsy and Other Paroxysmal Disorders. The Centre organises training conferences. Specialists in epilepsy and related fields ensure highest standards of the contributions.
         Conference participants can collect educational credit points which make them eligible for the Proficiency Certificate (in preparation by the Polish Society of Epileptology and the Ministry of Health). To get their points they must answer a questionnaire on the contents of the lectures. The Foundation is a member of the European Epilepsy Academy (EUREPA) and is entitled to organise training conferences provided the organiser meets certain standards. The Executive Board grants educational credit points for the EUREPA Epileptology Certificate on the Foundation's motion.
         Within the last year the Foundation organised 16 conferences for neurologists in various academic centres. The conferences were devoted to six general topics:
    1. Psychoses in epilepsy
    2. Interdisciplinary clinical assessment of pregnant epileptic women and their offspring
    3. Partial epilepsies
    4. Antiepileptic drugs in non-epileptic disorders
    5. Epilepsy after age 65
    6. Epileptic women's information concerning procreation
    See discussion below

         The first topic: Mental Disorders In Epilepsy was discussed in the following lectures:

    Pathophysiology of interictal psychoses in epilepsy - Jerzy Majkowski
    Psychoses in epilepsy: Clinical picture - Joanna Jędrzejczak
    Mental disorders as consequences of pharmacotherapy and neurosurgery - Beata Zwolińska
    Anxiety disorders in epilepsy - Krzysztof Owczarek

         Conferences were held in Białystok, Częstochowa, Katowice, Gdańsk, Szczecin, Warsaw and Wrocław.



    Report on the Research and Training Conference MENTAL DISORDERS IN EPILEPSY

         The conference on mental disorders in epilepsy was spread over several meetings held between the end of November 2003 and February 2004. To familiarise readers with the contents of the conference presentations here are some fragments of the reports prepared by Professor Teresa Korwin-Piotrowska and Professor Wiesław Drozdowski.
         Professor Jerzy Majkowski presented several different theories of the relations between epilepsy and interictal psychoses. He discussed four periods in the development of these theories within the last 150 years: 1. theories highlighting similarities between epilepsy and psychosis; 2. theories highlighting antagonisms between the disorders; 3. lack of recognition of relations between the two conditions, 4. according to the author, epilepsy and psychoses may have common pathogenetic dynamics (Majkowski, Epileptologia 1993).
         The author thinks that focal spike discharges may play an important role in the pathogenesis of "interictal" psychoses just as they do in epileptogenesis. Once the spike focus has developed, the kindling process begins. This process may lead to epileptic seizures, psychoses or both. Psychoses associated with a spike focus in the temporal lobe are a different form of psychoses from the ones which are not accompanied by epileptic discharges in the EEG.
         Many aetiopathogenetic factors are involved in mental disorders in epilepsy. Jerzy Majkowski thinks that the following ones are most important: lesions of the limbic system and subclinical EEG discharges. Other factors which may also contribute to some extent include sleep disorders, particularly interference with the REM phase; reduction of opiate level due to seizure control; neurochemical, hormonal, psycho-social and genetic disorders.
         The kindling theory of pathogenesis of psychoses is supported by the coincidence of symptoms and lack of sharp boundaries between the two pathological syndromes (Kraft et el., 1984) as well as the dynamic and continuity of the underlying process (Crow, 1990). Clinical observations corroborate these empirical findings (Kraepelin, 1921; Post et al., 1989).
         As far as the kindling theory and the role of epileptic discharges in patients manifesting psychotic disorders are concerned, it must be pointed out that large doses of antipsychotic and antidepressant drugs lower the threshold of epileptic discharges and do not bring the desirable effects. According to the author's experience, a combination of antiepileptic drugs and small doses of psychotropic drugs give better control of psychiatric symptoms and epileptic attacks than large doses of psychotropic drugs in this patient subgroup.
         Dr Joanna Jędrzejczak presented the clinical picture of psychoses and other mental disorders in epilepsy. She drew attention to the variety of clinical manifestations resulting from such factors as localisation of the epileptic focus, different patterns of discharge spreading and biological and psychological differences between patients. She also gave a palatable and interesting account of epileptic psychoses, divided into the following categories: paroxysmal, post-paroxysmal, peri-paroxysmal, inter-paroxysmal and alternative.
         Post-paroxysmal psychoses are the most frequent type (about 50% of all epileptic psychoses) and they include delusions, hallucinations or altered behaviour without disturbed consciousness which, do not set in directly after the attack but within 1-6 days of normal functioning (usually after a series of tonic-clonic seizures or status epilepticus). The next group to be discussed were inter-paroxysmal psychoses which amount to 30% of all epileptic psychoses. Risk factors for this group include female sex, a history of epilepsy lasting over a dozen years, focal epilepsy with the focus in the temporal lobe (left or bilateral), discharge proliferation to the limbic system and the nature of the pathology - gliomas and teratomas of the temporal lobe rather than gliosis. The author also gives an exact clinical account of these schizophrenoform psychoses which differ from schizophrenia in that they are not accompanied by affective disorder and rarely involve formal thought disorder. Interpersonal relations are warm and emotional and patients often have visual hallucinations and mystical or religious experiences.
         Much of the presentation and the discussion which followed was devoted to depressive disorders in epilepsy. These disorders may appear during the actual seizures or in the interictal period. Depressive symptoms during seizures may accompany status epilepticus, partial simple and partial complex seizures and are of course paroxysmal themselves. Usually, however, depression sets in between the epileptic seizures and epidemiological research indicates that this may apply to 50% of patients. Depressive disorders in epilepsy may resemble dysthymia or depressive episodes. They typically involve high levels of anxiety, irritability and obsessions.
         Dr Beata Zwolińska talked about mental disorders resulting from the pharmacotherapy or neurosurgery of epilepsy. All antiepileptic drugs affect the patient's mental condition, some positively, others negatively. Appearance of disorders may depend on the drugs themselves, on genetic disposition or psychiatric risk factors. Polytherapy, forced normalisation, toxicity or drug withdrawal may all have adverse effects on the patient's mental condition. Dr Zwolińska gave a comprehensive review of the psychotropic effects of antiepileptic drugs. Vigabatrine, tiagabine, topiramate, phenytoin and phenobarbital may all have adverse effects. Sympathetic effects should be expected when the patient is treated with carbamazepine, valproid acid, lamotrigine or gabapentin. This is why the latter group of drugs are used by psychiatrists to treat anxiety disorders, behaviour disorders, depression, bipolar depressive disorders, insomnia and withdrawal syndromes.
         Surgical treatment of epilepsy, particularly resection of the temporal lobe, may also cause mental disorders. Post-lobectomy psychoses develop in 2-6% of patients and depressive disorders in about 10%. When looking for pathogenetic factors, special attention is paid to family history of psychiatric disorders, organic changes (e.g., ganglioglioma, medial structure sclerosis) and the right cerebral hemisphere.
         Depressions and psychoses in epileptic patients seriously affect quality of life and are hard to treat because of the interactions between antiepileptic and antipsychotic drugs as well as the convulsion threshold. This applies largely to antidepressants such as amoxapine and maprotilline, mianserin and tricyclics. The safest treatments for depressive disorders in epileptic patients are doxepin, selective serotonin uptake inhibitors and moclobemide. Psychoses respond rapidly and well to introduction of small doses of neuroleptics.
         Dr Krzysztof Owczarek discussed anxiety disorders in epilepsy and pointed out that anxiety in epilepsy may be caused by social factors (e.g., stigmatisation), faulty child rearing practices (e.g., overprotection), pharmacotherapy or CNS disorders. Dr Owczarek drew attention to how the family may contribute to development of anxiety disorders and their treatment. He reminded listeners of the importance of faulty family attitudes towards the patient: epilepsy may be viewed as an embarrassing weakness, inevitable loss, enemy, action strategy, blessing or punishment. Meanwhile epilepsy should be treated as a "task". "The family adapts to the illness of a close relative. Family members are receptive to information on functional behaviour and make an effort to co-operate with the doctor".
         Professor Jerzy Majkowski could not attend the Szczecin conference and Professor Teresa Korwin-Piotrowska talked on point 4, i.e., patients with epileptic psychoses without epileptic seizures. All patients with this condition were young men aged 18, 19, 19 and 43. They refute the popular belief that sex is a risk factor for schizophrenoform psychoses. Two patients had mainly productive symptoms (delusions, hallucinations, ideas of self-reference) whereas the two remaining patients had negative symptoms (isolation, social withdrawal, loss of purpose in life, depressive mood). These disorders were not episodic. Their course resembled chronic psychosis and since they did not improve with neuroleptics, they were classified as drug resistant. These patients had very good emotional rapport, quite unlike the very shallow contact with schizophrenic patients, as if "through a pane of glass". It is worth noting that the first three patients were never given an EEG despite several psychiatric hospitalisations. The fourth patient had been suffering from psychiatric disorders for several years. They were mild at first then evolved into a paranoid syndrome. All these patients were diagnosed with epilepsy on the basis of repeated EEGs and subsiding of the psychiatric symptoms when an antiepileptic drug was introduced (this report is published in Epileptologia, 2004, 12: 267-277).
         The conference was interesting, as attested to by good attendance rates in all the centres and the long and interesting discussions which followed the presentations. The conference was possible thanks to the involvement of the Epileptology Foundation and Pfizer and the helpfulness of the Polish Society of Epileptology (participants were given participation certificates and educational credit points). Many thanks to them all in the name of all participant neurologists.

    Professor Teresa Korwin-Piotrowska, M. D.
    Professor Wiesław Drozdowski, M. D.



    (This report was published in Epileptologia, 2004, 12: 184-187)


    Second topic:

    Interdisciplinary clinical assessment of pregnant epileptic women and their offspring


    Program
    1. Epilepsy Centre for Pregnant Women - achievements and plans for 2004 - Jerzy Majkowski
    2. Teratogenic factors in foetal development - Marzena Mazurek
    3. Interactions between folic acid and antiepileptic drugs - Władysław Lasoń
    4. Standards of conduct with pregnant epileptic women - Ewa Motta
    5. Causes and consequences of status epilepticus in pregnant women and therapeutic intervention - Joanna Jędrzejczak

    The Polish national conference took place at the Marriott Hotel in Warsaw on 28 February 2004.



    Report on the Polish National Scientific Conference "The Interdisciplinary Clinical Evaluation of Pregnant Women with Epilepsy and their Offspring"

         The Polish National Scientific Conference "The Interdisciplinary Clinical Evaluation of Pregnant Women with Epilepsy and their Offspring" was held at the Mariott Hotel in Warsaw on 28 February 2004. The conference was organised by the Polish National Epilepsy Centre for Pregnant Women at the Epileptology Foundation and two pharmaceutical companies, Novartis and GlaxoSmithKline under the auspices of the Polish Society of Epileptology and the European Epilepsy Academy (EUREPA). Participants obtained educational credit points from both these organisations after filling in the appropriate questionnaires.

         The proceedings were chaired by Professor Jerzy Majkowski, from the Epileptology Foundation, who opened the conference with information on the Epilepsy Centre for Pregnant Women and reviewed the state of the art and plans for 2004. The Epilepsy Centre for Pregnant Women was opened at the Foundation of Epileptology in December 1999. It operates within the European Register of Antiepileptic Drugs and Pregnancy (EURAP), which is organised on the initiative of the International Against Epilepsy League. Experience gathered so far with respect to realisation of research procedures within the EURAP program suggest the need for optimisation. In 2003 the Centre referred 120 pregnant women with epilepsy to the European register. At the time of referral 69 patients (57%) were on monotherapy, 22% were on polytherapy (4 patients in this group were taking more than two antiepileptic drugs) and 25 women (21%) were not taking any medication. Of the 52 women whose pregnancies ended in 2003, 43 (83%) gave birth to healthy babies. Two pregnancies ended with miscarriages: one in 19 hbd (LTG+VPA) and one in 12 hbd (CBZ+VPA). Two foetuses were stillborn: one mother was taking CBZ and the other one was taking LTG. In 2004 the Epilepsy Centre for Pregnant Women began to train doctors and initiated a survey on knowledge about motherhood in epileptic women in Poland.

         The second speaker at the conference was Dr Marzena Mazurek from the Department of Gynaecology and Obstetrics, Medical Centre for Postgraduate Education, Warsaw. She talked about teratogenic factors in foetal development. These include a large group of toxic factors, e.g., chemical compounds, hormones and drugs. The author pointed out that major congenital defects are found in about 3% of all neonates, i.e., 30 in 1000, of which 10 are CNS defects, 8 - heart and large blood vessels, 4 - kidney, 2 - limbs and 6 - other organs. The foetus is at greatest risk before organogenesis is completed, i.e., within the first 60 days of conception.

         The next speaker was Professor Władysław Lasoń from the Institute of Pharmacology, Polish Academy of Sciences in Kraków. He talked about the interaction of folic acid and antiepileptic drugs. He said that folic acid deficiency exceeding 3ng/ml inhibits DNA methylation and increases protooncogene expansion. Folic acid also acts as a direct antioxidant and regulates the activity of endothelial nitrogen oxide synthase. Phenytoin, phenobarbitale, primidone and carbamazepine induce microsomal liver enzymes and thereby reduce the serum concentration of folic acid and increase the level of homocysteine which has a negative effect on foetal development. Some data suggest that, because folic acid alters phenytoin catabolism, it may also prevent the teratogenic consequences of valproic acid. The author stressed that there is no fixed set of rules for dosing folic acid although it is suggested that it be administered at a dose of 4 mg per day to epileptic women who plan to get pregnant and are treated with carbamazepine or valproic acid. New antiepileptic drugs generally do not affect folians and animal research has shown that they are not teratogenic. This last conclusion definitely must be verified in multi-centre clinical research, however.

         The next to speak was Dr Ewa Motta from the Department of Neurology, Upper Silesian Medical Centre, Silesian Medical Academy, Katowice. She presented the standard procedure for dealing with pregnant epileptic women and quoted data showing that 15-37% of these women have more frequent seizures during pregnancy, 13-25% have less frequent seizures and 50-88% show no change in the frequency of seizures. There are several possible reasons for the exacerbation of seizures in pregnancy but disturbed metabolism of antiepileptic drugs is probably the most common one. This is because absorption is reduced, distribution is increased, protein binding is interfered with and drug clearance is increased. When the doses of antiepileptic drugs are held constant, their serum concentration drops as the pregnancy develops to reach their lowest level during labour and then begin to increase again during puerperium. Conventional antiepileptic drugs have teratogenic effects whereas clinical experience with new generation drugs is still too small to merit any binding conclusions. Monotherapy with the smallest effective doses, drugs with controlled-release formulations and folic acid supplementation are recommended for pregnant epileptic women. According to the author, the vast majority of epileptic women can give birth naturally and should definitely breast feed.

         Dr Joanna Jędrzejczak from the Department of Neurology and Epileptology, Medical Centre for Postgraduate Education, Warsaw, discussed the causes and consequences of epileptic conditions in pregnant women and the recommended methods of intervention. About 1% of all women may have an epileptic condition for various reasons: hormonal, metabolic or pharmacological. However, the most frequent cause of the increased rate of seizures is probably failure to comply with doctors orders as to how to take antiepileptic drugs. Periodical foetal hypoxia is one of the factors responsible for abnormal foetal development. For this reason generalised tonic-clonic seizures are particularly dangerous for the foetus because they involve spells of maternal apnoea. Generalised tonic-clonic seizures also carry the risk of injury to the mother or to the foetus, e.g., due to falling. We must also bear in mind the possibility of cardiac dysfunction in the foetus and, in extreme cases, premature placental detachment. Despite all these hazards, most reports say that epileptic attacks in pregnancy are not a teratogenic risk factor but should be well controlled nevertheless because of the risk of status epilepticus. The relevant research findings suggest a high mortality rate in mothers and foetuses in status epilepticus in pregnancy. Abortion is a necessary element of therapy in such cases. Status epilepticus is life threatening but progress in the treatment of epilepsy as well as better care have considerably improved the chances of survival of the mother and the foetus during status epilepticus in pregnancy. The standards of treatment of status epilepticus are not any different from the ones for treatment of women during pregnancy and labour.

         The last speaker was Dr Janusz Wendorff from the Department of Neurology, Institute and Polish Mothers' Memorial Health Centre in ŁódĽ. He talked about the prospective evaluation of development of the offsprings of epileptic mothers. He stressed that risk of abnormal development largely depends on genetic factors, the effects of antiepileptic drugs administered during pregnancy, presence of tonic-clonic seizures and other environmental factors relating to the socio-economic conditions of life of the family in which the mother has epilepsy. The speaker's own research suggests that children of epileptic mothers weigh less at birth than children of control mothers (the difference levels out by about 2 years of age) and also have significantly smaller head circumference, particularly if the mother was treated with carbamazepine. The motor development of children of epileptic mothers is slower in the following three spheres: visual-motor co-ordination, speech and social contact. Five- and seven-year-olds were less developed on such dimensions as thought processes, visual-motor co-ordination, information and vocabulary. However, the total IQ of children of epileptic mothers was not significantly different from the total IQ of the control group. As far as seven and eight-year-olds are concerned, the offspring of epileptic mothers was more often dyslexic.

         The conference enabled presentation of world trends in the treatment of pregnant epileptic women. The Polish contribution to this field was also underscored. Participants learned that the Polish National Epilepsy Centre for Pregnant Women at the Foundation of Epileptology has done much to further the development of this branch of epileptology and support the work of the European Register of Antiepileptic Drugs and Pregnancy (EURAP). About 300 people attended the conference, most of them neurologists, gynaecologists and obstetricians. Very warm thanks to Novartis and GlaxoSmithKline for the excellent preparation and co-organisation of the conference.

    Board of the Foundation of Epileptology


    Topic three "Epilepsy with partial seizures - present and future" was represented by the following lectures:
    1. Heterogeneity of partial seizures - Joanna Jędrzejczak
    2. Treatment of partial epilepsy - Piotr Zwoliński
    3. Efficacy measures of epilepsy treatment with particular regard to children - Maria Mazurkiewicz-Bełdzińska
         The conference was held in Warsaw, Poznań, Lublin, Łódź and Gdańsk.

    Report on the Conference "Epilepsy with partial seizures - present and future"
         The conference on "Epilepsy with partial seizures - present and future" under the patronage of the Polish Society of Epileptology was held on 3 April 2004 in Warsaw. The Foundation of Epileptology Training Centre for Epilepsy and Other Paroxysmal Conditions was responsible for the scientific side of the conference and the pharmaceutical firm Novartis was responsible for the logistics. Professor Jerzy Majkowski, M. D. chaired the conference.
         The first speaker was Dr Joanna Jędrzejczak, M. D. from the Department of Neurology and Epileptology, Medical Centre for Postgraduate Education in Warsaw. Her presentation was devoted to the variety of forms of partial seizures. Analysis of long-term video EEG combined with observation of patient behaviour has allowed researchers to associate certain features of epileptic attacks with abnormalities in the EEG. This procedure is important for the localisation and lateralisation of the epileptic focus. Familiarity with the symptomatology and differential diagnostics of epileptic symptoms helps the doctor to make the correct diagnosis more quickly and initiate the correct therapeutic intervention.
         The second speaker was Dr Piotr Zwoliński, M. D. from the Department of Neurosurgery, Children's Memorial Hospital, Warsaw. He talked about the principles of pharmacotherapy for the successful treatment of partial epilepsy. New generation antiepileptic drugs should be highly effective, easy and safe to use and should also be useful in various treatment protocols. The speaker then went on to point out that the holistic model of health care combining all aspects of the epileptic patient's life is now gaining importance in the treatment of epileptic seizures. Holistic procedures cover all the essential medical and extra-medical disciplines which are needed to ensure normal social functioning for patients.
         The last speaker was Dr Maria Mazurkiewicz-Bełdzińska, M. D. from the Department of developmental Neurology at the Medical Academy, Gdańsk. She talked about the factors which should be taken into account when selecting antiepileptic drugs. The purpose of therapy is to maintain a normal life style by achieving full control of the seizures without adverse effects. The key to therapeutic success is correct diagnosis based on a sound knowledge of the pathophysiology of epileptic attacks. It is also extremely important that the medical professional be familiar with the mechanisms of action of antiepileptic drugs, pharmacokinetics and potential drug interactions. Careful diagnosis and analysis of the patient's conditions of life are also an essential element of successful therapy. The doctor must take time to cope with fear, misconceptions and biases in both the patient and the patient's family.
         The conference was repeated in the four other academic centres. The lectures are published in Epileptologia, 2004, 12 (Supplement 2): 5-36.
         Participants were given questionnaires to fill in and could obtain educational credit points from the Polish Society of Epileptology.

    This report was published in Epileptologia, 2004, 12: 187-188.

         Theme four: Antiepileptic Drugs in Non-epileptic Disorders was presented during a satellite symposium at the XVIII Conference of the Polish Society of Epileptology in Warsaw on 20 May 2004. The Foundation of Epileptology was responsible for the scientific organisation and Polpharma sponsored the conference (conference proceedings: Epileptologia, 2004, 12, Supplement 1 and the Conference program).



         Theme five: Epilepsy After Age 65 was presented during a satellite symposium at the XVIII Conference of the Polish Society of Epileptology in Warsaw on 21 May 2004. The Foundation of Epileptology was responsible for the scientific organisation and Pfizer sponsored the conference (conference proceedings: Epileptologia, 2004, 12, Supplement 1 and the Conference program).



         Theme six: Epileptic Women's Information Concerning Procreation was presented during the XII Symposium on Epilepsy and Pregnancy, Warsaw, 20 May 2004 which preceded the XVIII Conference of the Polish Society of Epileptology. The symposium was organised by the Foundation of Epileptology and sponsored by Novartis and GlaxoSmithKline (conference proceedings: Epileptologia, 2004, 12, Supplement 1 and Epileptologia, 2004, 12: 295).




    The Polish National Session on
    "Epilepsy - Go Out and Face Life",
    19 February 2005

         A Polish national session on epilepsy called "Epilepsy - Go Out and Face Life" was held at the Jan III Sobieski Hotel in Warsaw on 19 February 2005. This was the first conference for patients and with the participation of patients with epilepsy. The session was organised by the Epileptology Foundation and the pharmaceutical company GlaxoSmithKline. The Polish Association of People Suffering from Epilepsy offered its patronage. Seventy patients, members of various associations of patients with epilepsy, attended the conference. There are 12 associations of this kind in Poland, 9 of which are branches of the Polish Association of People Suffering from Epilepsy which was founded in 1985 and whose headquarters are in Białystok. The three other associations were established much later and are seated in Poznań, Warsaw and Gdańsk. The conference was also attended by neurologists, psychologists and a medical expert and also by non-professionals interested in epilepsy, both journalists and patients' families.

         Two moderators, Dr Beata Różycka and Dr Krzysztof Owczarek, M.D. opened the conference. Dr Owczarek introduced the audience to the problems of quality of life in epileptic patients. Very important from both the doctor's point of view and the point of view of the patient was Dr Beata Różycka's contribution stressing the significance of appropriate choice of drug and the education of society with respect to epilepsy. To overcome the myths concerning epilepsy, combat discrimination of epileptic patients and activate them - these were the most important assumptions of GlaxoSmithKline's educational program "Epilepsy - Go out and Face Life" launched in May 2004.

         The leading theme of the first part of the conference was the social functioning of epileptic patients together with all the aspects relating to the limitations accompanying the disease. Problems such as whether or not epileptic patients should be allowed to have driving licenses, finding a job and quality of life of epileptic patients were discussed.

         Members of the Warsaw-based Association for Epileptic Patients and their Friends "Calm Head" were also invited to present papers. Anna Osucha-Olawa described the everyday life of epileptic patients. One of her conclusions was that there is a great need for broadly-understood education on epilepsy, its symptoms, consequences and how to help the patient who is having a seizure. Sylwia Zadrożna, author of the second patient paper, talked about the problem of driving licenses for epileptic patients. Research into this issue has shown that healthy respondents who are unfamiliar with epilepsy are unanimous that epileptic patients should not have driving licenses. The main reason for their scepticism is lack of adequate information on the nature of the disease and the control of epileptic attacks. Most patient families also do not think patients should take their driving test. The last topic in this part of the conference, devoted to the employment problems of epileptic patients, was presented by Anna Kali¶ciak. The speaker talked about important issues relating to employment of epileptic patients and their problems with getting an education and finding a job. A half-hour recess provided ample opportunity for participants to discuss the presented problems and to talk to the speakers.

         The second part of the conference was devoted to treatment of epilepsy in pregnant women and employment incapacity of epileptic patients and the granting of invalid pension. Dr Joanna Jędrzejczak, M.D., who presented the problems of epilepsy and pregnancy, drew attention to the most important problems confronted by epileptic women, i.e., planning pregnancy, systematic consultations with their doctor during pregnancy and breast feeding after childbirth. The topic which evoked most controversy and the most heated discussion was expert opinions for patients applying for invalid pension, presented by Dr Marta Greese-Łyko. Since patients had personally experienced the procedures involved in granting invalid pension they became very involved in the discussion with the expert. The leading theme of the discussion which followed the presentation was criteria for granting invalid status to epileptic patients. Professor Jerzy Majkowski, M.D. who joined the presiding convenors together with Barbara Majkowska M.A., President of The Foundation of Epileptology, joined into the discussion. Tadeusz Zarębski, President of the Polish Association for Persons Suffering from Epilepsy, answered on behalf of the participants. After the discussion everybody went to have lunch.

         The third part of the Session took place at the "Old Powder-Magazine" Gallery in Warsaw's Old City where the Epileptology Foundation and members of the Association for Epileptic Patients and their Friends "Calm Head" organised an exhibition of their work entitled "The Artistic Creations of Epileptic Patients and their Friends". Visitors could view exhibits in different techniques: drawings, paintings, stained glass, tapestries and many others. They also had the opportunity to talk to the authors and purchase some of the hand-crafted items.

    Anna Kali¶ciak, Agnieszka Krajnik