Form Structure: Seizure Diary

Short Name:
SeizureDiary
Description:
This CRF Module is recommended for all studies that need to collect seizure occurrence data on a daily basis. It is completed by the participant/ subject and brought to study visits. The physician/ coordinator will then review the diary with the patient and ask them to describe each of his/ her seizures. Each seizure type is then assigned a single code.
Disease:
Epilepsy
Organization:
NINDS
Required Program Form:
No
Standardization:
Other NINDS
Version:
1.0
Date Created:
2014-04-09
Created By:
Number of Data Elements:
5
eForms:
N

Attached Data Elements

# Title Short Description Variable Name Required? Type
1 Seizure diary date and time   Date (and time, if applicable and known) the diary data are recorded SeizDiaryDateTime Optional CDE
2 Seizure daily diary no seizure indicator   The indicator of whether the participant/subject experienced NO seizures on the corresponding date SeizDlyDiaryNoSeizInd Optional CDE
3 Seizure daily diary seizure type   The type of seizure experienced by the participant/subject on the corresponding date SeizDlyDiarySeizTyp Optional CDE
4 Seizure daily diary seizure type count   The number of seizures of the particular seizure type that the participant/subject experienced on the corresponding date SeizDlyDiarySeizTypCt Optional CDE
5 Seizure diary completer type   The person completing the diary SeizDiaryCompltrTyp Optional CDE

Additional Element Groups

There are no additional data element groups.