Patient's initials
Item
Patient's initials
text
C2986440 (UMLS CUI [1])
Patient's trial number
Item
Patient's trial number
text
C2348585 (UMLS CUI [1])
Center number
Item
Center number
text
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Date of Assessment
Item
Date of Assessment
date
C2985720 (UMLS CUI [1])
Age of the patient at first seizure
Item
Age of the patient at first seizure
integer
C0001779 (UMLS CUI [1,1])
C0036572 (UMLS CUI [1,2])
C0205435 (UMLS CUI [1,3])
Age of the patient at first seizure
Item
Age of the patient at first seizure
integer
C0001779 (UMLS CUI [1,1])
C0036572 (UMLS CUI [1,2])
C0205435 (UMLS CUI [1,3])
Does the patient have a history of an infantile spasms syndrome?
Item
Does the patient have a history of an infantile spasms syndrome?
boolean
C0037763 (UMLS CUI [1,1])
C0231330 (UMLS CUI [1,2])
C0039082 (UMLS CUI [1,3])
Item
Is the aetiology Cryptogenic or Symptomatic?
integer
C1314792 (UMLS CUI [1,1])
C0086237 (UMLS CUI [1,2])
C1314792 (UMLS CUI [2,1])
C0231220 (UMLS CUI [2,2])
Code List
Is the aetiology Cryptogenic or Symptomatic?
Item
If aetiology is symptomatic and there is a definitive specific aetiology, please check all that apply
integer
C1314792 (UMLS CUI [1,1])
C0231220 (UMLS CUI [1,2])
C1314792 (UMLS CUI [2,1])
C2348235 (UMLS CUI [2,2])
Code List
If aetiology is symptomatic and there is a definitive specific aetiology, please check all that apply
CL Item
Prenatal - congenital infection, specify (1)
CL Item
Prenatal - non specific dysmorphology (2)
CL Item
Prenatal - specific dysmorphology, specify (3)
CL Item
Prenatal - identifiable chromosomal abnormality, specify (4)
CL Item
Prenatal - single gene defect, specify (5)
CL Item
Prenatal - other, specify (6)
CL Item
Perinatal - extreme prematurity (7)
CL Item
Perinatal - definite perinatal asphyxia (8)
CL Item
Perinatal - definite cerebral haemorrhage (9)
CL Item
Perinatal - neonatal seizures of unknown cause (10)
CL Item
Perinatal - neonatal seizures identifiable cause, specify (11)
CL Item
Perinatal - neonatal sepsis (12)
CL Item
Perinatal - other, specify (13)
CL Item
Postnatal - CNS infection (14)
CL Item
Postnatal - CNS injury/ trauma (15)
CL Item
Postnatal - Other, specify (16)
Specify aetiology
Item
Specify, if aetiology is congenital infection, specific dysmorphology, identifiable chromosomal abnormality, single gene defect, neonatal seizures indentifiable cause or other
text
C1314792 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
C0009450 (UMLS CUI [2,1])
C0000768 (UMLS CUI [2,2])
C0814936 (UMLS CUI [3,1])
C2348235 (UMLS CUI [3,2])
C0008625 (UMLS CUI [4])
C0037176 (UMLS CUI [5])
C0036572 (UMLS CUI [6,1])
C2939425 (UMLS CUI [6,2])
Other major neurological diagnoses
Item
Other major neurological diagnoses
text
C0027765 (UMLS CUI [1,1])
C0205164 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Item
How is the patient's intellectual function?
integer
C0233821 (UMLS CUI [1])
Code List
How is the patient's intellectual function?
CL Item
Mildly impaired (2)
CL Item
Moderately impaired (3)
CL Item
Severely impaired (4)
If normal or mildly impaired intellectual function, is there a clinical impression of deterioration?
Item
If normal or mildly impaired intellectual function, is there a clinical impression of deterioration?
boolean
C0683322 (UMLS CUI [1,1])
C1279889 (UMLS CUI [1,2])
Item
Does the patient have a history of status epilepticus?
text
C0038220 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Code List
Does the patient have a history of status epilepticus?
Date of last occurence (status epilepticus)
Item
Date of last occurence (status epilepticus)
date
C2745955 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C0038220 (UMLS CUI [1,4])
Item
Status epilepticus
integer
C0038220 (UMLS CUI [1])
Code List
Status epilepticus
CL Item
major tonic-clonic (1)
CL Item
minor motor status (2)
CL Item
absence status (3)
If other status epilepticus, please specify
Item
If other status epilepticus, please specify
text
C0038220 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Has the patient had epilepsy surgery?
Item
Has the patient had epilepsy surgery?
boolean
C0014544 (UMLS CUI [1,1])
C0543467 (UMLS CUI [1,2])
Item
If the patient had epilepsy surgery, check all that apply.
integer
C0014544 (UMLS CUI [1,1])
C0543467 (UMLS CUI [1,2])
Code List
If the patient had epilepsy surgery, check all that apply.
If other epilepsy surgery, please specify
Item
If other epilepsy surgery, please specify
text
C0014544 (UMLS CUI [1,1])
C0543467 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])