Outcomes following exposure to lacosamide monotherapy during pregnancy and breastfeeding - a prospective case series.

AIM OF THE STUDY: To evaluate the safety of lacosamide (LCM) monotherapy during pregnancy and breastfeeding. MATERIAL AND METHODS: Patients taking LCM monotherapy treated at the university epilepsy clinic were prospectively followed up during pregnancy, delivery, and breastfeeding. Data on seizure frequency, LCM dosage, pregnancy course, delivery and breastfeeding, birth outcome, congenital malformation, and development of newborns was collected. RESULTS: Four pregnancies in three patients with refractory focal epilepsy treated with LCM monotherapy were reported. One of these pregnancies ended in a miscarriage during the seventh week of gestation. The average daily LCM dose at the time of conception was 300 mg. Treatment with LCM was continued throughout pregnancy and breastfeeding. The dose of LCM was increased in two pregnancies: in one case following a seizure relapse, and in the other case as a preventive measure to avoid an increase in seizure frequency. Seizure frequency remained stable during pregnancy in two cases. All deliveries were carried out via caesarean section, with an average gestational age at birth of 37.6 weeks. The Apgar score was 10 in all newborns, and no congenital malformations were detected. At the age of 12 months, normal developmental milestones were reached. Infants were breastfed without any complications. CONCLUSIONS AND CLINICAL IMPLICATIONS: This case series adds to a growing body of evidence suggesting the relative safety of LCM monotherapy throughout pregnancy and breastfeeding.

Trends in antiseizure medications utilization among women of childbearing age with epilepsy in Poland between 2015 and 2019.

PURPOSE: To determine trends in the use of antiseizure medications (ASMs) among women of childbearing age (WOCA) and girls aged 12-14 years with epilepsy between 2015 and 2019 in Poland. METHODS: The study used data from the Pex database, which captures information on prescriptions dispensed from 85% of community pharmacies in Poland. The prescriptions issued by neurologists who provide epilepsy care in Poland were studied. Six of the most commonly prescribed ASMs were analyzed: carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, topiramate, and valproate. RESULTS: The use of valproate and carbamazepine decreased in all age groups. Among the newer ASMs, the use of lamotrigine, levetiracetam, and topiramate increased and oxcarbazepine decreased significantly in WOCA. The only subgroup with statistically significant changes in all ASMs prescriptions were women aged 19-34 years. For girls aged 12-14 years, significant changes were found only for valproate and carbamazepine. In the last year of observation (2019) valproate and lamotrigine accounted for two-thirds of ASMs units prescribed to WOCA. Valproate accounted for half of the prescribed drug units in girls aged 12-14 years. The lowest rates of VPA prescriptions were found in women aged 19-34 years. CONCLUSIONS: There is a change in prescribing habits in WOCA with epilepsy in Poland with trends toward using less teratogenic ASMs. However, many WOCAs are treated with valproate and topiramate despite their known teratogenicity risk. Valproate is still the most commonly prescribed ASM in WOCA and girls aged 12-14 years. Educational interventions for healthcare professionals are needed to improve prescribing practices in WOCA with epilepsy in Poland.

High prevalence of electroencephalographic frontal intermittent rhythmic delta activity in patients with moderately severe COVID-19.

INTRODUCTION: The aim of our study was to analyse EEG findings in patients with COVID-19 not requiring respiratory support. MATERIAL AND METHODS: We reviewed EEGs performed in patients with COVID-19 between April 2020 and May 2021 at the University Hospital in Kraków, Poland. Demographic and clinical data, including comorbid conditions, discharge disposition, survival, neuroimaging findings, laboratory results, and treatment was collected. RESULTS: The study included 44 EEGs performed in 35 patients (51.4% females), aged 65.5 ± 13.9 years. Almost all patients had at least one comorbidity, and one-third had one or more preexisting neurological conditions. Three quarters of EEGs were abnormal. The most frequent EEG finding was background slowing (16 patients; 45.7%). Frontal findings included frontally predominant rhythmic delta (FIRDA) in 10 (28.6%) patients and focal slowing in the left frontal lobe. Patients with abnormal EEG significantly more often required oxygen supplementation (p = 0.003) and were less likely to recover (p = 0.048). CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients with COVID-19 infection may frequently manifest with an abnormal EEG. FIRDA seems to be a frequent EEG pattern in less severe cases of COVID-19 infection. Future studies are needed to establish whether COVID-19 infection increases the risk for FIRDA, and to investigate its pathogenesis.

Long-term cenobamate retention, efficacy, and safety: outcomes from Expanded Access Programme.

AIM OF THE STUDY: To evaluate the long-term retention rate, efficacy, and tolerability of adjunctive cenobamate (CNB) in patients with drug-resistant epilepsy within the Polish Expanded Access Programme (EAP). CLINICAL RATIONALE FOR THE STUDY: Long-term retention rate is a useful measure of effectiveness including efficacy, safety, and tolerability of antiseizure medications. MATERIAL AND METHODS: We conducted a multicentre retrospective analysis of consecutive patients with focal epilepsy treated with CNB in the EAP between January 2020 and May 2023. All patients who completed the open-label extension phases of the YKP3089C013 and YKP3089C017 trials were offered the opportunity to continue CNB treatment within the EAP. We analysed cenobamate retention, seizure outcomes, and adverse events. RESULTS: 38 patients (18 females; 47.3%) continued CNB treatment within the Expanded Access Programme for 41 months. The mean baseline age of patients was 39.3 years (range: 18-57). All patients were on polytherapy, with the most commonly used antiseizure medications being valproate, levetiracetam, and carbamazepine. Adjunctive CNB treatment resulted in a reduced mean seizure frequency from 8.1 seizures (range: 4-20) per month to 3 seizures (range: 0-8) per month. At the final follow-up, the median CNB dose was 200 mg/day (range: 50-350). Among the patients, 24 (63.1%) achieved ≥ 50% seizure reduction, and eight (21%) remained seizure-free for at least 12 months. One in three patients experienced adverse events, which resolved in half of the subjects. The most frequent adverse events were dizziness, somnolence, and headache. The retention rate after completing the open-label extension phase was 100%. CONCLUSIONS AND CLINICAL IMPLICATIONS: Long-term effectiveness, including ≥ 50% seizure reduction and a 100% retention rate, was sustained over 41 months of CNB treatment within the Expanded Access Programme. No new safety issues were identified. These results provide support for the potential long-term clinical benefits of cenobamate.

COVID-19 among patients with epilepsy: Risk factors and course of the disease.

INTRODUCTION: The study assessed the prevalence and risk factors for SARS-CoV-2 infection in patients with epilepsy (PWE). Additionally, the course of COVID-19 and its impact on seizure control was investigated. MATERIAL AND METHODS: Subjects with definite (confirmed by positive RT-PCR nasopharyngeal swab or serum anti-SARS-CoV-2 antibodies) and probable COVID-19 were identified via telephone survey among PWE treated at the university epilepsy clinic. RESULTS: Of 252 screened subjects, 17 (6.7%) had definite and 14 (5.5%) probable COVID-19. The percentage of PWE with definite COVID-19 was much higher than the percentage of subjects with confirmed COVID-19 in Polish general population (3.65%). In the heterogenous population of PWE, including patients with drug-resistant epilepsy, physical/intellectual disability, and comorbidities, we were not able to identify any risk factors for contracting COVID-19. The course of infection was mild or moderate in all subjects, not requiring oxygen therapy or respiratory support. The most common symptoms were fever, fatigue, headaches, muscle aches, and loss of smell/taste and continued for approximately 7-21 days, except for loss of smell/taste which lasted usually several weeks. Seizure exacerbation was noted in only one pregnant patient with confirmed COVID-19 and it was likely related to decreased serum level of levetiracetam in the third trimester. CONCLUSION: The study provided reassuring findings related to the low risk of seizure exacerbation in PWE during the course of COVID-19. Patients with epilepsy may be at increased risk of SARS-CoV-2 infection. Epilepsy characteristics are not likely to modify the risk of COVID-19.

Genetic testing and the phenotype of Polish patients with Unverricht-Lundborg disease (EPM1) - A cohort study.

AIM OF THE STUDY: The aim of this study was to explore genetic findings and the phenotype in Polish patients with Unverricht-Lundborg disease (ULD). MATERIALS AND METHODS: We retrospectively evaluated mutations in the cystatin B (CSTB) gene and clinical presentation in a cohort of patients with ULD. The study population consisted of 19 (14 males) patients with genetically confirmed disease. RESULTS: Sixteen patients were homozygous for the expanded dodecamer repeat mutation alleles, one subject was compound heterozygous for the dodecamer repeat expansion and other mutation, in two, the type of mutation has not yet been established. The numbers of repeats in the CSTB gene varied from 60 to 81. Clinical information was available for 16 subjects. The disease course was progressive in all patients, leading to severe disability, mainly due to myoclonus, in nine. CONCLUSIONS AND CLINICAL IMPLICATIONS: Genetic findings and the clinical picture of our patients with ULD were in accordance with available studies. The most common genetic defect underlying ULD was homozygosity for an unstable expansion of a dodecamer repeat in the CSTB gene. Patients with action or/and stimulus sensitive myoclonus or intractable myoclonus epilepsy, especially with onset in late childhood/adolescence should be screened for ULD.

Predictors of remission in patients with epilepsy.

AIM OF STUDY: To evaluate the rate and factors predicting seizure remission in a large cohort of patients with epilepsy. MATERIALS AND METHODS: Patients with epilepsy treated at a university epilepsy clinic were included in this study. The following information was collected by means of a structured questionnaire: age, sex, age at onset of epilepsy, aetiology of epilepsy, the presence of intellectual disability, duration and type of epilepsy, frequency of seizures, treatment of epilepsy, and mechanism of action of antiepileptic drugs (AEDs). RESULTS: A total of 530 adult patients participated in this study (mean age ± standard deviation: 36.1 ± 12.6 years). Of these, 327 (61.7%) were female, and 364 (68.7%) patients had focal epilepsy. Twelve-month seizure freedom was achieved in 246 (46.4%) patients. Logistic regression revealed several independent predictors of seizure freedom: younger age (odds ratio (OR) = 0.98; p = 0.037), male sex (OR = 1.54; p = 0.050), generalised epilepsy (OR = 1.61; p = 0.052), lower number of prescribed AEDs (OR = 0.22; p = 0.001), and taking a combination of valproate and lamotrigine (OR = 2.51; p = 0.024). CONCLUSIONS: Most patients with epilepsy enter remission on monotherapy with their first or second AED. However, a substantial proportion of patients may benefit from combination therapy including valproate and lamotrigine polytherapy.

Obstetric and neonatal outcomes in women with epilepsy in Poland - a two-centre study.

AIM OF THE STUDY: To report pregnancy, delivery and perinatal outcomes in women with epilepsy seen in university clinics in Poland. Clinical rationale for the study. Women with epilepsy are reported to be at increased risk of adverse pregnancy and foetal outcomes. MATERIALS AND METHODS: The following data was collected in 171 pregnant women seen in two university epilepsy clinics: epilepsy characteristics and treatment, seizure frequency, pregnancy outcomes, perinatal outcomes, and feeding method. RESULTS: The mean age of patients at the time of delivery was 28.8 years, and most women were nulliparous. Almost 80% of patients were on monotherapy and the majority were prescribed antiepileptic drugs with low teratogenic potential. 53.8% of patients were seizure-free during pregnancy. Half of the cohort delivered by caesarean section and the majority delivered in term. Nearly all newborns scored > 7 Apgar points. Major congenital malformation was diagnosed in only one foetus. Any adverse pregnancy/neonatal outcome was found in 13% of patients. Two thirds of women reported breastfeeding at any time. CONCLUSIONS AND CLINICAL IMPLICATIONS: Almost 90% of women continued antiepileptic therapy during pregnancy. 46% of patients had epileptic seizures during pregnancy. Any adverse pregnancy/neonatal outcome was found in 13% of women with epilepsy. The majority of patients delivered healthy babies. Further studies are needed to find risk factors for adverse pregnancy/neonatal outcomes in women with epilepsy in Poland.

Use of complementary and alternative medicine among adults with epilepsy in a university epilepsy clinic in Poland.

INTRODUCTION: The use of complementary and alternative medicine (CAM) is becoming increasingly prevalent both in general population and patients with chronic diseases. The aim of the study was to determine the prevalence, reasons, and factors influencing the use of CAM in Polish patients with epilepsy (PWE). MATERIAL AND METHODS: This prospective study involved PWE treated in a university epilepsy clinic. Data on epilepsy, antiepileptic drugs, level of education, vocational activity, and patterns of CAM were collected from a structured interview and from medical records. RESULTS: The sample population consisted of 473 PWE (mean age: 35.3 years); 220 (46.5%) were females, and 228 (46.5%) were in remission. Overall 26.8% (127) of the cohort used at least one type of CAM. The CAM modalities most frequently used were herbal and dietary supplements (32.3%), energy healing (31.5%), and marijuana (27.6%). The internet was the most common source of information on CAM (45.7%). In one-third of subjects, CAM usage affected negatively compliance to standard treatment. Logistic regression analysis revealed several independent risk factors for CAM use in PWE: younger age, longer duration of epilepsy, lack of remission, and lower level of education. CONCLUSION: A significant proportion of PWE uses CAM, and its usage may affect negatively compliance to standard treatment. Our findings highlight poor communication between patients and physicians with regard to CAM use. Healthcare professionalists should routinely check for CAM utilization in PWE to prevent potential harm related to its use.

Why do some women with epilepsy use valproic acid despite current guidelines? A single-center cohort study.

OBJECTIVE: Current guidelines and regulations strongly discourage the use of valproic acid (VPA) in women of childbearing age because of the risk of congenital malformations and neurodevelopmental disability in children exposed to VPA in utero. Our goal was to establish the reasons for continued use of VPA in a cohort of women with epilepsy (WWE) and to characterize the subgroup of WWE who do not consent to withdraw VPA despite potential risks. MATERIAL AND METHODS: The study included consecutive adult premenopausal WWE who visited an outpatient epilepsy clinic between April 2017 and March 2018. Data on demographics (age, age at onset of epilepsy), characteristics of epilepsy (types and frequency of seizures), and its treatment were collected from medical records and seizure diaries. All WWE taking VPA were regularly informed about VPA-related risks and had the opportunity to discuss the withdrawal of VPA. RESULTS: The study involved 353 WWE (mean age: 31.7 years). Focal epilepsy was diagnosed in 244 (69.1%) patients; 180 (51.0%) women had no seizures during last 12 months before the study visit, and 228 patients (64.6%) were on monotherapy. A total of 146 (41.3%) patients used VPA in the past, and 98 (27.8%) never used VPA. Of women who were currently on VPA (n = 109, 30.9%), 30 had concurrent severe disabilities that would make future pregnancy extremely unlikely, in further 15 patients, VPA was recommenced because of failure of alternative treatment and 64 women did not accept the plan of VPA withdrawal. Women currently on VPA were more likely to have genetic generalized epilepsy and to be on monotherapy (both p ≪ 0.001). Among 64 WWE who decided to continue therapy with VPA, 35 (55.5%) had generalized epilepsy and 35 (55.5%) were in remission, 27 (42.2%) had at least one child, 9 (14.1%) planned to have a child in the near future but only 15 (23.4%) used effective contraception. CONCLUSION: Treatment with VPA is unavoidable in many WWE of childbearing age despite recent regulations. About 60% of WWE currently treated with VPA do not consent to withdraw VPA treatment after thorough consideration of potential risks and other 40% use VPA because pregnancy is highly unlikely and/or other treatments failed.

Implementation of the new ILAE classification of epilepsies into clinical practice - A cohort study.

PURPOSE: Appropriate management of patients with epilepsy requires precise classification of their disease. Implementation of the recent International League Against Epilepsy (ILAE) classification of seizures and epilepsies may affect data on the relative proportions of specific types of seizures or epilepsies and should be tested in everyday practice. The aim of the study was to determine the prevalence of specific epilepsy types, syndromes, and etiologies, as defined by the new ILAE classification, in a large cohort of adult patients with epilepsy. MATERIAL AND METHODS: The single-center cohort study involved consecutive adult patients with epilepsy seen at the university epilepsy clinic. Information about medical history, neurological examination, neuroimaging, electroencephalography (EEG), genetic tests, epilepsy treatment, and other investigations was collected from medical records and prospectively updated if necessary. Epilepsy types and etiology, as well as epileptic syndromes, were classified according to the new ILAE classifications. RESULTS: We studied 653 patients (mean age: 37.2 years, 59.9% were women). Epilepsy was classified as focal in 458 cases (70.2%), generalized in 155 subjects (23.7%), or as combined focal and generalized in 11 patients (1.7%). The epilepsy type was labeled as unknown in 29 (4.4%) patients. A definite cause of epilepsy was identified in 59.4% of the cases, with a structural etiology (n = 179, 27.4%) and genetic or presumed genetic etiology (n = 169, 25.9%) being the most common. In 167 (25.5%) patients, specific epilepsy syndromes, mostly genetic generalized epilepsy syndromes, were diagnosed. CONCLUSION: The use of the recent ILAE classification of seizures and epilepsies in the cohort of patients with epilepsy seen in single epilepsy center enabled unequivocal characterization of epilepsy type in >95% of patients. A definite etiology of epilepsy could be established in about 60% of patients.

Psychiatric comedication in patients with epilepsy.

Psychiatric disorders are more common in patients with epilepsy than in the general population. The aims of the study were to assess the frequency and type of psychotropic drug usage in patients with epilepsy, to assess the risk factors for their use, and to assess their proconvulsive potential and the risk of interactions with antiepileptic drugs. This 20-month prospective study included patients treated at the university hospital outpatient clinic. Psychotropic drugs have been classified according to the Anatomical Therapeutic Chemical Classification System. Of the 621 patients (with a mean age of 35.4years), 60% were women, and 37.5% were in remission; 54.8% of the patients used antiepileptic drug monotherapy. The most commonly used antiepileptic drugs were valproate, levetiracetam, lamotrigine, and carbamazepine. Eighty-nine (14.3%) patients received psychiatric comedication. Sertraline, perazine, and hydroxyzine were the predominantly used psychotropic drugs. Independent variables associated with psychotropic drug usage in the logistic regression model included age, active epilepsy, combined focal and generalized epilepsy type, use of somatic comedication, and phenobarbital. Over one-third of the patients simultaneously received antiepileptic drugs and psychotropic drugs, between which clinically significant interactions may occur, 10% of patients used psychotropic drugs to lower the seizure threshold. The results of the study indicate the need for closer cooperation between doctors of various specialties when caring for patients with epilepsy.

[Anxiety and depressive symptoms in epilepsy in the context of defense mechanisms and electrodermal activity]. / Objawy leku i depresji w padaczce w kontekscie mechanizmów obronnych i aktywnosci elektrodermalnej.

Depressive and anxiety disorders among people with epilepsy are more common than in general population and they are associated with less efficient emotion regulation and reduced quality of life. Unfortunately, these disorders are not always correctly diagnosed or treated. Some studies suggest that the electrodermal activity may serve as a marker for depression. AIM: The aim of the study was to measure and compare depressive and anxiety symptoms, defense mechanisms and electrodermal activity in response to cognitive stimulation in patients with epilepsy with the control group, and to test the correlations between symptoms of anxiety and depression, defense mechanisms and the electrodermal activity. MATERIALS AND METHODS: 64 patients diagnosed with epilepsy and 66 people from the control group were assessed with following psychological questionnaires: State-Trait Anxiety Inventory, Beck Depression Inventory, Defense Styles Questionnaire 40. MindLAB Set was used to measure electrodermal activity. RESULTS: The study showed that people with epilepsy tend to have increased levels of anxiety and depressive symptoms compared with the control group. Patients also tend to use neurotic defense mechanisms what may be associated with poorer emotion regulation. Electrodermal activity was lower among people with epilepsy after cognitive stimulation. There was no statistically significant correlation between electrodermal activity, anxiety and depressive symptoms. CONCLUSIONS: The results indicate the need for assessment of anxiety, depressive symptoms and types of defense mechanisms among patients with epilepsy, as appropriate psychotherapeutic and/or pharmacological intervention could significantly improve the quality of life of these patients.

Suicidality and its determinants among Polish patients with epilepsy.

BACKGROUND AND PURPOSE: The aim of this study was to evaluate the prevalence of suicidal ideation among Polish patients with epilepsy and to assess the potential determinants of suicidality in this cohort. MATERIAL AND METHODS: The study comprised 301 patients with epilepsy seen in the tertiary epilepsy clinic. Patients' characteristics included demographic variables, epilepsy-related variables, as well as occurrence of comorbidities, ongoing use of any other medications, family history of epilepsy and/or depression. Beck Depression Inventory (BDI) was used to assess depressive symptoms, and question no. 9 of BDI was specifically used to reveal suicidality. RESULTS: Mean age of subjects was 35.5 years. 113 (37.5%) had frequent seizures and 96 patients (31.9%) had remission. BDI score>11 points (suggestive for depression) was found in 127 subjects. Suicidal ideation has been revealed in 30 (10.0%) out of 301 studied patients. Patients with suicidal ideation were older and more commonly reported frequent seizures. Almost all of them (93.3%) had clinically significant depressive symptoms (BDI score>11). Multivariate analysis revealed that severity of depressive symptoms (OR=1.16 per one-point increase in BDI score, 95% CI: 1.10-1.22, p<0.001) and the use of potentially depressogenic medication (OR=3.04, 95% CI: 1.04-8.89, p=0.04) were independent determinants of suicidality among studied patients. CONCLUSIONS: Suicidal ideations were revealed by about 10% of studied epileptic patients who visited tertiary center for epilepsy. Independent predictors of suicidality among studied patients included depression itself and the use of potentially depressogenic medication.

Subtypes of interictal depressive disorders according to ICD-10 in patients with epilepsy.

BACKGROUND AND PURPOSE: The purpose of the study was to evaluate the frequency of interictal depressive symptoms and different subtypes of depressive disorders according to 10th revision of the International Classification of Diseases (ICD-10) criteria in patients with epilepsy and its association with the type of epilepsy. MATERIAL AND METHODS: 289 outpatients with epilepsy (169 females, 120 males) aged 18-82 years completed Beck Depression Inventory (BDI). Subjects who scored >11 in BDI were further evaluated by the psychiatrist according to the ICD-10 diagnostic criteria. RESULTS: 41.9% (121) of the 289 participants scored >11 in BDI. 104 (85.9%) patients who scored >11 in BDI had comorbid mental disorders according to ICD-10 criteria. The most common were organic mood disorders (F06.3 - 31.4%), depressive episode (F32 - 22.3%) and dysthymia (F34.1 - 9.1%) There were no differences in the prevalence of depression and subtypes of depression in patients with certain epilepsy types. Depression was diagnosed before entering the study in only one third of patients with final diagnosis of depression. CONCLUSIONS: Our results confirm the prevailing view that interictal depression is common in epilepsy patients. Depression remains underrecognized and undertreated in patients with epilepsy.

Treatment patterns in women of childbearing age and pregnant women with epilepsy in Poland between the years 2019 and 2022-A nationwide population-based cohort study.

AIM: To describe the antiseizure medications (ASMs) prescription pattern in women of childbearing age (WOCA) and pregnant women with epilepsy in the 2019-2022 period in Poland MATERIALS AND METHODS: The National Health Fund (NHF) databases were analyzed. Women aged 15-49 years were considered as being of childbearing age, while exposure during pregnancy was estimated taking into account 15 months before delivery. ASMs belonging to the N03A subgroup of the Anatomical Therapeutic Chemical Classification System, reimbursed by NHF were analyzed. RESULTS: During 2019, 36 784 WOCA and 921 pregnant women filled at least 1 ASM prescription. In 2022, these numbers were 32 304 and 594, respectively. Valproate was the most widely used ASM in WOCA (38.4 %) in 2019, followed by levetiracetam (35.6 %), lamotrigine (30.1 %), and carbamazepine (20.0 %). The percentage of ASM users decreased in 2022 for valproate (32.1 %; p < 0.001) and carbamazepine (17 %; p < 0.001) and increased for levetiracetam (40.8 %; p < 0.001) and lamotrigine (32.7 %; p < 0.001). In 2019 lamotrigine (42.1 %) and levetiracetam (41.5 %) were the most frequently prescribed ASMs to pregnant women. During the study period, a significant increase in prescriptions for levetiracetam was observed (49.5 %; p = 0.003). The proportion of ASMs exposed pregnancies declined for valproate (from 24.7 to 16 %; p < 0.001) and topiramate (from 6.6 to 3.2 %; p = 0.005). The percentage of polytherapy regimens remained stable over the years, both for WOCA (39 %) and pregnant women (32 %). CONCLUSION: Despite the decline in valproate usage, the drug was still among the most commonly prescribed ASMs in women of childbearing age and pregnant women with epilepsy. The awareness of teratogenic risks and new treatment guidelines should be improved in Poland.