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Let's Talk Seizure Diaries!
Novela Neurotech: Inspiring Better Cures
Your responses will help improve a new, wearable seizure diary for people with epilepsy.
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* Indicates required question
Are you a ___________________
*
Person with epilepsy
Caregiver for a loved one with epilepsy
Other:
Required
What should we call you? (First name, last initial is fine if you'd like to be anonymous)
*
Your answer
Age range of person with epilepsy?
*
18 or younger
19 - 29
30 - 64
65 or older
I'd rather not say
Other:
How many years ago were you or your loved one diagnosed with epilepsy? (Please round to the nearest number.)
*
Your answer
What type of epilepsy are you or your loved one diagnosed with (if known)?
Your answer
Are you or your loved one currently on medication to manage seizures?
*
Yes
No
Other:
If seizure medication is used, rate the experience of remembering to take the medication on time (1 -very easy; 5 - very difficult)
*
Very easy
1
2
3
4
5
Very difficult
Do you or your loved one ever use a seizure diary?
*
Yes
No
I don't know what a seizure diary is
How often do you log your seizures into the diary?
Daily
Weekly
About twice a month
Monthly
It's hard to remember
I don't use a seizure diary
Other:
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