| Demographic Data |
| Relation to Proband |
mother |
| Age at Sampling |
36 YR |
| Gender |
Female |
| Age of Onset(If not a control) |
10 MO |
| Age at Diagnosis(If not a control) |
10 MO |
| Hispanic or Latino/Not Hispanic or Latino |
Not Hispanic/Latino |
| Racial Category |
White |
| Country |
USA |
| Diagnosed By |
No Data |
| |
| Data Elements |
| Clinical Element Type: Control |
| (Baseline) |
| Data collected by |
| This data was collected by |
Neurologist Other physician-non-Neurologist clinical research assistant/nurse |
| Longitudinal Data |
| Is this data Longitudinal (Follow-Up) Data? |
yes no |
| Type of Control |
| Type of Control |
Related to an affected individual (REQUIRES SPECIAL APPROVAL) |
| Medical History |
| Amyotrophic lateral sclerosis |
present absent |
| Ataxia |
present absent |
| Autism |
present absent |
| Bipolar (manic-depressive) |
present absent |
| Brain aneurysm |
present absent |
| Cancer |
present absent |
| Dementia |
Alzheimer's
Dementia
absent
|
| Depression |
present absent |
| Diabetes |
present absent |
| Dystonia |
present absent |
| Epilepsy |
present absent |
| Heart disease |
present absent |
| Hypertension |
present absent |
| Memory loss |
present absent |
| Migraine |
present absent |
| Multiple sclerosis |
present absent |
| Muscle disease |
present absent |
| Obsessive Compulsive |
present absent |
| Parkinson's |
present absent |
| Schizophrenia |
present absent |
| Stroke |
present absent |
| Suicide/Attempt |
present absent |
| Tourettes |
present absent |
| Other |
present absent |
| Family History |
| Amyotrophic lateral sclerosis |
present absent |
| Ataxia |
present absent |
| Autism |
present absent |
| Bipolar (manic-depressive) |
present absent |
| Brain aneurysm |
present absent |
| Cancer |
present absent
Notes: PATERNAL GRANDMOTHER - PANCREAS, MATERNAL GRANDFATHER - COLON, PATERNAL GRANDFATHER |
| Dementia |
Alzheimer's
Dementia
absent
Notes: PATERNAL GRANDMA, MATERNAL GRANDMA, AND MOTHER |
| Depression |
present absent
Notes: MOTHER AND MATERNAL GRANDFATHER |
| Diabetes |
present absent
Notes: MATERNAL GRANDMOTHER AND MATERNAL GREAT GRANDFATHER |
| Dystonia |
present absent |
| Epilepsy |
present absent
Notes: DAUGHTER ND22800 |
| Heart disease |
present absent |
| Hypertension |
present absent |
| memory loss |
present absent |
| Migraine |
present absent |
| Multiple sclerosis |
present absent |
| Muscle disease |
present absent |
| Obsessive Compulsive |
present absent |
| Parkinson's |
present absent |
| Schizophrenia |
present absent |
| Stroke |
present absent
Notes: MATERNAL GREAT GRANDMOTHER |
| Suicide/Attempt |
present absent
Notes: PATERNAL GREAT UNCLE |
| Tourettes |
present absent |
| Other |
present absent
Notes: SUDDEN DEATH - MATERNAL GRANDMOTHER (BLOOD CLOT), THYROID DISORDERS - MOTHER |
| Optional data |
| smoking history |
never former smoker current smoker |
| years smoking |
No Data |
| Neurological examination |
yes no |
| State Examination (MMSE) score |
No Data |
| Handedness |
Right Left Ambidextrous |
| Clinical Element Type: Epilepsy |
| (Baseline) |
| Longitudinal Data |
| Is this data Longitudinal (Follow-Up) Data? |
yes no |
| Family History |
| Family history of epilepsy |
present absent unknown (subject adopted)
Notes: CHILD HAS DRAVETS |
| Family history of other paroxysmal disorder: Migraine |
present absent unknown |
| Family history of other paroxysmal disorder: Dystonia |
present absent unknown |
| Other family members of this person in NINDS repository |
yes no
Notes: ND22800, ND22804 |
| Genetic Data of Subject |
| Known genetic syndrome |
No Data |
| Mutation/s in subject's DNA (if present, describe) |
present absent unknown |
| Seizure Type |
| Focal motor /autonomic/aura |
yes no |
| Focal dyscognitive |
yes no |
| Focal evolving to generalized convulsion |
yes no |
| Generalized - typical absence |
yes no |
| Generalized - atypical absence |
yes no |
| Myoclonic |
yes no |
| Clonic |
yes no |
| Tonic |
yes no |
| Tonic-Clonic |
yes no |
| Atonic |
yes no |
| Infantile spasms |
yes no |
| Unclassifiable seizure type |
yes no |
| Status epilepticus |
yes no |
| Simple febrile seizure |
yes no |
| Complex febrile seizure |
yes no |
| Prolonged febrile seizure |
yes no |
| Etiology |
| Etiology |
Idiopathic |
| Specific etiology if known |
Trauma
Stroke
Hypoxia
Meningitis
Encephalitis
Antenatal insult
Error in brain development (specify)
Cortical dysphasia
Mitochondrial disorder
Chromosomal disorder (specify)
Other (specify)
Unknown
|
| Seizure Disorders - Epilepsy: >2 unprovoked seizures (Age of onset, if applicable) |
Yes No |
| Seizure Disorders - Single Unprovoked seizure (Age at occurrence, if applicable) |
Yes No |
| Seizure Disorders - Febrile seizures (Age of onset, if applicable) |
Yes No |
| Seizure Disorders - Status Epilepticus (Age of onset, if applicable) |
Yes No |
| Seizure Disorders - Acute Symptomatic Seizures (Age of onset, if applicable) |
Yes No |
| Seizure Disorders - Other (Age of onset, if applicable) (Age of onset, if applicable) |
Yes No |
| Associated conditions |
Cerebral palsy
Mental retardation
Autism
Dementia
Neurodegenerative disorder
None known
Other (specify)
|
| Treatment |
| Medically refractory |
yes no unknown |
| Surgical treatment |
yes no |
| Tests |
| EEG |
not done |
| Generalized spike and wave |
No Data |
| Focal spikes |
No Data |
| Nonepileptiform abnormalities focal slowing |
No Data |
| Imaging |
normal abnormal not done |
| Smoking History |
| smoking history |
never former smoker current smoker |
| years smoking |
No Data |
| Miscellaneous |
| Neurological examination |
yes no |
| Handedness |
Right Left Ambidextrous |
| State Examination (MMSE) score |
No Data |