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Seizure history and information/ Epilepsy information - Screen

1 Formulär  
Administrative
Beskrivning

Administrative

Alias
UMLS CUI-1
C1320722
Site number
Beskrivning

Study Site; Numbers

Datatyp

text

Alias
UMLS CUI [1,1]
C2825164
UMLS CUI [1,2]
C0237753
Patient's initials
Beskrivning

Person Initials

Datatyp

text

Alias
UMLS CUI [1]
C2986440
Patient's trial number
Beskrivning

Clinical Trial Subject Unique Identifier

Datatyp

text

Alias
UMLS CUI [1]
C2348585
Date of assessment
Beskrivning

Assessment Date

Datatyp

date

Alias
UMLS CUI [1]
C2985720
Seizure history
Beskrivning

Seizure history

Alias
UMLS CUI-1
C0036572
UMLS CUI-2
C0262926
Etiology - check one.
Beskrivning

Etiology

Datatyp

integer

Alias
UMLS CUI [1]
C1314792
If etiology is symptomatic, specify.
Beskrivning

Etiology; Symptomatic

Datatyp

text

Alias
UMLS CUI [1,1]
C1314792
UMLS CUI [1,2]
C0231220
Age at first seizure (excluding febrile seizures)
Beskrivning

Age; Seizures; First (number) | Febrile Convulsions

Datatyp

float

Måttenheter
  • years
Alias
UMLS CUI [1,1]
C0001779
UMLS CUI [1,2]
C0036572
UMLS CUI [1,3]
C0205435
UMLS CUI [2]
C0009952
years
Seizure information
Beskrivning

Seizure information

Alias
UMLS CUI-1
C0036572
UMLS CUI-2
C1533716
Seizure code
Beskrivning

Seizures; Code

Datatyp

text

Alias
UMLS CUI [1,1]
C0036572
UMLS CUI [1,2]
C0805701
Date of last occurence
Beskrivning

Occurrence; Last; Date in time

Datatyp

date

Alias
UMLS CUI [1,1]
C2745955
UMLS CUI [1,2]
C1517741
UMLS CUI [1,3]
C0011008
Number of seizures
Beskrivning

Seizures; Count

Datatyp

float

Alias
UMLS CUI [1,1]
C0036572
UMLS CUI [1,2]
C0750480
Unit (specify unit as: day, week, month [4 weeks] or year)
Beskrivning

Unit | day | week | month | year

Datatyp

text

Alias
UMLS CUI [1]
C0439148
UMLS CUI [2]
C0439228
UMLS CUI [3]
C0439230
UMLS CUI [4]
C0439231
UMLS CUI [5]
C0439234
Epilepsy information
Beskrivning

Epilepsy information

Alias
UMLS CUI-1
C0014544
UMLS CUI-2
C1533716
Seizure Classification (Use ICE CODES)
Beskrivning

Seizures; Classification

Datatyp

text

Alias
UMLS CUI [1,1]
C0036572
UMLS CUI [1,2]
C0008902
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Similar models

Seizure history and information/ Epilepsy information - Screen

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative
C1320722 (UMLS CUI-1)
Study Site; Numbers
Item
Site number
text
C2825164 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Person Initials
Item
Patient's initials
text
C2986440 (UMLS CUI [1])
Clinical Trial Subject Unique Identifier
Item
Patient's trial number
text
C2348585 (UMLS CUI [1])
Assessment Date
Item
Date of assessment
date
C2985720 (UMLS CUI [1])
Item Group
Seizure history
C0036572 (UMLS CUI-1)
C0262926 (UMLS CUI-2)
Item
Etiology - check one.
integer
C1314792 (UMLS CUI [1])
Etiology
Code List
Etiology - check one.
CL Item
Idiopathic (1)
CL Item
Symptomatic (2)
Etiology; Symptomatic
Item
If etiology is symptomatic, specify.
text
C1314792 (UMLS CUI [1,1])
C0231220 (UMLS CUI [1,2])
Age; Seizures; First (number) | Febrile Convulsions
Item
Age at first seizure (excluding febrile seizures)
float
C0001779 (UMLS CUI [1,1])
C0036572 (UMLS CUI [1,2])
C0205435 (UMLS CUI [1,3])
C0009952 (UMLS CUI [2])
Item Group
Seizure information
C0036572 (UMLS CUI-1)
C1533716 (UMLS CUI-2)
Item
Seizure code
text
C0036572 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
Seizures; Code
Code List
Seizure code
CL Item
Simple partial seizures (Consciousness not impaired)- With motor signs - focal motor without march (A1a)
CL Item
Simple partial seizures (Consciousness not impaired)- With motor signs - focal motor with march (Jacksonian) (A1b)
CL Item
Simple partial seizures (Consciousness not impaired)- With motor signs - Versive (A1c)
CL Item
Simple partial seizures (Consciousness not impaired)- With motor signs - Postural (A1d)
CL Item
With somatosensory or special- sensory symptoms - Somatosensory (A2a)
CL Item
With somatosensory or special- sensory symptoms - Visual (A2b)
CL Item
With somatosensory or special- sensory symptoms - Auditory (A2c)
CL Item
With somatosensory or special- sensory symptoms - Olfactory (A2d)
CL Item
With somatosensory or special- sensory symptoms - Gustatory (A2e)
CL Item
With somatosensory or special- sensory symptoms - Vertiginous (A2f)
CL Item
With autonomic symptoms or signs (including epigastric sensation, pallor, sweating, flushing, piloerection, and pupillary dilatation) (A3)
CL Item
With psychic symptoms - Dysphasic (A4a)
CL Item
With psychic symptoms - Dysmnesic (e. g. deja- vu) (A4b)
CL Item
With psychic symptoms - Cognitive (e. g. dreamy states and distortions of time sense) (A4c)
CL Item
With psychic symptoms - Affective (fear, anger, etc.) (A4d)
CL Item
With psychic symptoms - Illusions (e. g. macropsia) (A4e)
CL Item
With psychic symptoms - Structured hallucinations (e. g. music, scenes) (A4f)
CL Item
Simple partial onset followed by impairment of consciousness - With simple partial features (A1- A4) followed by impaired consciousness (B1a)
CL Item
Simple partial onset followed by impairment of consciousness - With automatisms (B1b)
CL Item
With impairment of consciousness at onset - With impairment of consciousness only (B2a)
CL Item
With impairment of consciousness at onset - With automatism (B2b)
CL Item
Partial seizures evolving to secondarily generalized seizures (GS) - Simple partial seizures (A) evolving to GS (C1)
CL Item
Partial seizures evolving to secondarily generalized seizures (GS) - Complex partial (B) evolving to GS (C2)
CL Item
Partial seizures evolving to secondarily generalized seizures (GS) - Simple partial seizures (A) evolving to complex partial seizures (B) evolving to GS (C3)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - Typical Abscence (D1a)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - Impairment of consciousness only (D1ai)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - With mild clonic component (D1aii)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - With atonic component (D1aiii)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - With tonic component (D1aiv)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - With automatisms (D1av)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - With autonomic components (Mixed forms of D1ai- D1avi may occur and should be dosumented by using all applicable code numbers) (D1avi)
CL Item
Atypical Absence (D1b)
CL Item
Changes in tone that are more pronounced than D1a (D1bi)
CL Item
Onset and/ or cessation that is not abrupt (D1bii)
CL Item
Myoclonic seizures (myoclonic jerks- single or multiple) (D2)
CL Item
Clonic seizures (D3)
CL Item
Tonic seizures (D4)
CL Item
Tonic- clonic seizures (D5)
CL Item
Atonic seizures (astatic) (D6)
CL Item
Combination of any of the above generalized seizured may occur and should be documented by using all applicable codde numbers. (Combination of any of the above generalized seizured may occur and should be documented by using all applicable codde numbers.)
CL Item
Unclassified Seizures (E)
Occurrence; Last; Date in time
Item
Date of last occurence
date
C2745955 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Seizures; Count
Item
Number of seizures
float
C0036572 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
Unit | day | week | month | year
Item
Unit (specify unit as: day, week, month [4 weeks] or year)
text
C0439148 (UMLS CUI [1])
C0439228 (UMLS CUI [2])
C0439230 (UMLS CUI [3])
C0439231 (UMLS CUI [4])
C0439234 (UMLS CUI [5])
Item Group
Epilepsy information
C0014544 (UMLS CUI-1)
C1533716 (UMLS CUI-2)
Item
Seizure Classification (Use ICE CODES)
text
C0036572 (UMLS CUI [1,1])
C0008902 (UMLS CUI [1,2])
Seizures; Classification
Code List
Seizure Classification (Use ICE CODES)
CL Item
Simple partial seizures (Consciousness not impaired)- With motor signs - focal motor without march (A1a)
CL Item
Simple partial seizures (Consciousness not impaired)- With motor signs - focal motor with march (Jacksonian) (A1b)
CL Item
Simple partial seizures (Consciousness not impaired)- With motor signs - Versive (A1c)
CL Item
Simple partial seizures (Consciousness not impaired)- With motor signs - Postural (A1d)
CL Item
With somatosensory or special- sensory symptoms - Somatosensory (A2a)
CL Item
With somatosensory or special- sensory symptoms - Visual (A2b)
CL Item
With somatosensory or special- sensory symptoms - Auditory (A2c)
CL Item
With somatosensory or special- sensory symptoms - Olfactory (A2d)
CL Item
With somatosensory or special- sensory symptoms - Gustatory (A2e)
CL Item
With somatosensory or special- sensory symptoms - Vertiginous (A2f)
CL Item
With autonomic symptoms or signs (including epigastric sensation, pallor, sweating, flushing, piloerection, and pupillary dilatation) (A3)
CL Item
With psychic symptoms - Dysphasic (A4a)
CL Item
With psychic symptoms - Dysmnesic (e. g. deja- vu) (A4b)
CL Item
With psychic symptoms - Cognitive (e. g. dreamy states and distortions of time sense) (A4c)
CL Item
With psychic symptoms - Affective (fear, anger, etc.) (A4d)
CL Item
With psychic symptoms - Illusions (e. g. macropsia) (A4e)
CL Item
With psychic symptoms - Structured hallucinations (e. g. music, scenes) (A4f)
CL Item
Simple partial onset followed by impairment of consciousness - With simple partial features (A1- A4) followed by impaired consciousness (B1a)
CL Item
Simple partial onset followed by impairment of consciousness - With automatisms (B1b)
CL Item
With impairment of consciousness at onset - With impairment of consciousness only (B2a)
CL Item
With impairment of consciousness at onset - With automatism (B2b)
CL Item
Partial seizures evolving to secondarily generalized seizures (GS) - Simple partial seizures (A) evolving to GS (C1)
CL Item
Partial seizures evolving to secondarily generalized seizures (GS) - Complex partial (B) evolving to GS (C2)
CL Item
Partial seizures evolving to secondarily generalized seizures (GS) - Simple partial seizures (A) evolving to complex partial seizures (B) evolving to GS (C3)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - Typical Abscence (D1a)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - Impairment of consciousness only (D1ai)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - With mild clonic component (D1aii)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - With atonic component (D1aiii)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - With tonic component (D1aiv)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - With automatisms (D1av)
CL Item
Generalized seizures (Convulsive or Non- convulsive) - With autonomic components (Mixed forms of D1ai- D1avi may occur and should be dosumented by using all applicable code numbers) (D1avi)
CL Item
Atypical Absence (D1b)
CL Item
Changes in tone that are more pronounced than D1a (D1bi)
CL Item
Onset and/ or cessation that is not abrupt (D1bii)
CL Item
Myoclonic seizures (myoclonic jerks- single or multiple) (D2)
CL Item
Clonic seizures (D3)
CL Item
Tonic seizures (D4)
CL Item
Tonic- clonic seizures (D5)
CL Item
Atonic seizures (astatic) (D6)
CL Item
Combination of any of the above generalized seizured may occur and should be documented by using all applicable codde numbers. (Combination of any of the above generalized seizured may occur and should be documented by using all applicable codde numbers.)
CL Item
Unclassified Seizures (E)
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