Abstract：
Valproate (VPA) is an effective treatment for epilepsy and also used in bipolar disorder. However, VPA is associated with a significant risk of birth defects and developmental disorders if used during pregnancy. This has led to the introduction of measures to reduce the use of valproate in women of childbearing potential such as the \'Prevent\' pregnancy prevention program (PPP) and the completion of an annual risk acknowledgement form (ARAF). The aim of the current audit was to assess compliance with the guidance. An audit tool was made available to neurologists registered with the Association of British Neurologists (ABN) and to epilepsy nurse specialists via the Epilepsy Nurses Association (ESNA) in the UK. Data were collected between November 2020 and March 2021. The main indication for valproate was generalised epilepsy (55.8%), followed by focal (22.5%). For most, there was documentation that the woman had been informed about the risks associated with taking valproate during pregnancy (93.1%) and the need to be on highly effective contraception or that this was not deemed appropriate (92.2%). A signed ARAF was available in the notes for 81.2% although only 66% were <12 months old. Although information had been made available for most women, there were still individuals where this was not documented. Further work is needed to facilitate identification of women taking valproate and implementation of a digital ARAF. For clinicians, the audit highlights a need to carefully counsel women about the teratogenic risks of continuing to take valproate versus the risk of deteriorating seizure control if the drug is withdrawn. This is particularly true of women with focal epilepsy, where there may be safer, equally effective, alternative anti-seizure medication (ASM). The aim should be to create a partnership of trust between the patient and clinician in order to arrive at the best clinical decision for that individual.
摘要：
丙戊酸（VPA）是一种有效的治疗癫痫，也用于双相情感障碍。然而,如果在怀孕期间使用VPA，则与出生缺陷和发育障碍的显着风险相关。这导致采取了减少有生育潜力的妇女使用丙戊酸盐的措施，例如“预防”怀孕预防计划（PPP）和完成年度风险确认表（ARAF）。当前审计的目的是评估对指南的遵守情况。审计工具已提供给在英国神经学家协会（ABN）注册的神经学家，并通过英国的癫痫护士协会（ESNA）提供给癫痫护士专家。数据收集时间为2020年11月至2021年3月。丙戊酸盐的主要适应症是全身性癫痫（55.8％），其次是病灶(22.5%)。对于大多数人来说，有文件表明,该妇女已被告知与怀孕期间服用丙戊酸钠相关的风险(93.1%)和需要进行高效避孕或认为这不合适(92.2%).签名的ARAF在笔记中有81.2%，尽管只有66%的年龄<12个月。尽管已经为大多数妇女提供了信息，仍然有个人没有记录。需要进一步的工作来促进识别服用丙戊酸盐的妇女并实施数字ARAF。对于临床医生来说，审计强调，有必要就继续服用丙戊酸钠的致畸风险与停药后癫痫发作控制恶化的风险向女性提供仔细的咨询。对于患有局灶性癫痫的女性尤其如此，那里可能更安全，同样有效，替代抗癫痫药物（ASM）。目的应该是在患者和临床医生之间建立信任的伙伴关系，以便为个人做出最佳的临床决定。
