Item
Genetic or presumed genetic OR epilepsy of unknown cause
integer
C2724370 (UMLS CUI [1])
Code List
Genetic or presumed genetic OR epilepsy of unknown cause
Item
Structural or metabolic
integer
C2724370 (UMLS CUI [1])
Code List
Structural or metabolic
Item
Viral, bacterial and parasitic infections
integer
C0009450 (UMLS CUI [1])
Code List
Viral, bacterial and parasitic infections
Item
Viral, bacterial and parasitic infections
integer
C0009450 (UMLS CUI [1])
Code List
Viral, bacterial and parasitic infections
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Infections
Item
Viral, bacterial and parasitic infections: If more than one specific etiology, please specify
text
C0009450 (UMLS CUI [1])
Item
Traumatic brain injury
integer
C0876926 (UMLS CUI [1])
Code List
Traumatic brain injury
Item
Traumatic brain injury
integer
C0876926 (UMLS CUI [1])
Code List
Traumatic brain injury
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Traumatic brain injury
Item
Traumatic brain injury: If more than one specific etiology is selected, specify
text
C0876926 (UMLS CUI [1])
Item
Stroke
integer
C0038454 (UMLS CUI [1])
Item
Stroke
integer
C0038454 (UMLS CUI [1])
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Stroke
Item
Stroke: If more than one specific etiology is selected, specify:
text
C0038454 (UMLS CUI [1])
Item
Intraventricular hemorrhage
integer
C0240059 (UMLS CUI [1])
Code List
Intraventricular hemorrhage
Item
Intraventricular hemorrhage
integer
C0240059 (UMLS CUI [1])
Code List
Intraventricular hemorrhage
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Intraventricular hemorrhage
Item
Intraventricular hemorrhage: If more than one specific etiology is selected, specify:
text
C0240059 (UMLS CUI [1])
Item
Hypoxic-ischemic encephalopathy
integer
C0149878 (UMLS CUI [1])
Code List
Hypoxic-ischemic encephalopathy
Item
Hypoxic-ischemic encephalopathy
integer
C0149878 (UMLS CUI [1])
Code List
Hypoxic-ischemic encephalopathy
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Hypoxic-ischemic encephalopathy
Item
Hypoxic-ischemic encephalopathy: If more than one specific etiology is selected, specify:
text
C0149878 (UMLS CUI [1])
Item
Other metabolic or toxic insults
integer
C0600688 (UMLS CUI [1])
C0006112 (UMLS CUI [2])
Code List
Other metabolic or toxic insults
Item
Other metabolic or toxic insults
integer
C0600688 (UMLS CUI [1])
C0006112 (UMLS CUI [2])
Code List
Other metabolic or toxic insults
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Other metabolic or toxic insults
Item
Other metabolic or toxic insults:If more than one specific etiology is selected, specify:
text
C0600688 (UMLS CUI [1])
C0006112 (UMLS CUI [2])
Item
Neurocutaneous syndromes
integer
C0265316 (UMLS CUI [1])
Code List
Neurocutaneous syndromes
Item
Neurocutaneous syndromes
integer
C0265316 (UMLS CUI [1])
Code List
Neurocutaneous syndromes
Neurocutaneous syndromes
Item
Neurocutaneous syndromes: If more than one specific etiology is selected, specify:
text
C0265316 (UMLS CUI [1])
Item
Inborn errors of metabolism
integer
C0025521 (UMLS CUI [1])
Code List
Inborn errors of metabolism
Item
Inborn errors of metabolism
integer
C0025521 (UMLS CUI [1])
Code List
Inborn errors of metabolism
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Inborn errors of metabolism
Item
Inborn errors of metabolism:If more than one specific etiology is selected, specify:
text
C0025521 (UMLS CUI [1])
Item
Genetic and chromosomal development encephalopathies
integer
C0085584 (UMLS CUI [1,1])
C0008626 (UMLS CUI [1,2])
C0314603 (UMLS CUI [1,3])
Code List
Genetic and chromosomal development encephalopathies
Item
Genetic and chromosomal development encephalopathies
integer
C0085584 (UMLS CUI [1,1])
C0008626 (UMLS CUI [1,2])
C0314603 (UMLS CUI [1,3])
Code List
Genetic and chromosomal development encephalopathies
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Genetic and chromosomal development encephalopathies
Item
Genetic and chromosomal development encephalopathies: If more than one specific etiology is selected, specify
text
C0085584 (UMLS CUI [1,1])
C0008626 (UMLS CUI [1,2])
C0314603 (UMLS CUI [1,3])
Item
Developmental encephalopathy of unknown cause as evidenced by the presence of mental retardation, cerebral palsy, or autism with no evidence of a specific insult of disorder to which cause can be attributed preceding the onset of epilepsy
integer
C0085584 (UMLS CUI [1,1])
C0458003 (UMLS CUI [1,2])
C1385132 (UMLS CUI [1,3])
Code List
Developmental encephalopathy of unknown cause as evidenced by the presence of mental retardation, cerebral palsy, or autism with no evidence of a specific insult of disorder to which cause can be attributed preceding the onset of epilepsy
Item
Developmental encephalopathy of unknown cause as evidenced by the presence of mental retardation, cerebral palsy, or autism with no evidence of a specific insult of disorder to which cause can be attributed preceding the onset of epilepsy
integer
C0085584 (UMLS CUI [1,1])
C0458003 (UMLS CUI [1,2])
C1385132 (UMLS CUI [1,3])
Code List
Developmental encephalopathy of unknown cause as evidenced by the presence of mental retardation, cerebral palsy, or autism with no evidence of a specific insult of disorder to which cause can be attributed preceding the onset of epilepsy
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Developmental encephalopathy of unknown cause
Item
Developmental encephalopathy of unknown cause as evidenced by the presence of mental retardation, cerebral palsy, or autism with no evidence of a specific insult of disorder to which cause can be attributed preceding the onset of epilepsy: If more than one specific etiology is selected, specify
text
C0085584 (UMLS CUI [1,1])
C0458003 (UMLS CUI [1,2])
C1385132 (UMLS CUI [1,3])
Item
Malformations of cortical or other brain development with or without known genetic determinants
integer
C1955869 (UMLS CUI [1])
C0266449 (UMLS CUI [2])
Code List
Malformations of cortical or other brain development with or without known genetic determinants
Item
Malformations of cortical or other brain development with or without known genetic determinants
integer
C1955869 (UMLS CUI [1])
C0266449 (UMLS CUI [2])
Code List
Malformations of cortical or other brain development with or without known genetic determinants
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Malformations of cortical or other brain development
Item
Malformations of cortical or other brain development with or without known genetic determinants: If more than one specific etiology is selected, specify
text
C1955869 (UMLS CUI [1])
C0266449 (UMLS CUI [2])
Item
Neoplasia
integer
C1882062 (UMLS CUI [1])
Item
Neoplasia
integer
C1882062 (UMLS CUI [1])
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Neoplasia
Item
Neoplasia: If more than one specific etiology is selected, specify
text
C1882062 (UMLS CUI [1])
Item
Mesial temporal sclerosis
integer
C2062593 (UMLS CUI [1])
Code List
Mesial temporal sclerosis
Item
Mesial temporal sclerosis
integer
C2062593 (UMLS CUI [1])
Code List
Mesial temporal sclerosis
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Mesial temporal sclerosis
Item
Mesial temporal sclerosis: If more than one specific etiology is selected, specify
text
C2062593 (UMLS CUI [1])
Item
Dementia
integer
C0497327 (UMLS CUI [1])
Item
Dementia
integer
C0497327 (UMLS CUI [1])
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Dementia
Item
Dementia: If more than one specific etiology is selected, specify
text
C0497327 (UMLS CUI [1])
Item
Other degenerative neurologic diseases
integer
C0524851 (UMLS CUI [1])
Code List
Other degenerative neurologic diseases
Item
Other degenerative neurologic diseases
integer
C0524851 (UMLS CUI [1])
Code List
Other degenerative neurologic diseases
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Genetic or presumed genetic
Item
Genetic or presumed genetic, if known specify:
text
C0017399 (UMLS CUI [1])
Item
Genetic or presumed genetic
integer
C0017399 (UMLS CUI [1])
Code List
Genetic or presumed genetic
Item
Genetic or presumed genetic
integer
C0017399 (UMLS CUI [1])
Code List
Genetic or presumed genetic
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Genetic or presumed genetic,
Item
Genetic or presumed genetic, if more than one specific etiology is selected, specify:
text
C0017399 (UMLS CUI [1])
Item
Epilepsy of unknown cause, without relevant abnormalities on examination, cognition, history, or imaging
integer
C0086237 (UMLS CUI [1])
Code List
Epilepsy of unknown cause, without relevant abnormalities on examination, cognition, history, or imaging
Item
Epilepsy of unknown cause, without relevant abnormalities on examination, cognition, history, or imaging
integer
C0086237 (UMLS CUI [1])
Code List
Epilepsy of unknown cause, without relevant abnormalities on examination, cognition, history, or imaging
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Epilepsy of unknown cause
Item
Epilepsy of unknown cause without relevant abnormalities on examination, cognition, history, or imaging:If more than one specific etiology is selected, specify
text
C0086237 (UMLS CUI [1])
Other Etiology
Item
Other Etiology, specify:
text
C0205394 (UMLS CUI [1,1])
C0015127 (UMLS CUI [1,2])
Item
Other etiology
integer
C0205394 (UMLS CUI [1,1])
C0015127 (UMLS CUI [1,2])
Item
Other etiology
integer
C0205394 (UMLS CUI [1,1])
C0015127 (UMLS CUI [1,2])
CL Item
Primary cause (1)
CL Item
Secondary cause (2)
Other etiology
Item
Other etiology,If more than one specific etiology is selected, specify:
text
C0205394 (UMLS CUI [1,1])
C0015127 (UMLS CUI [1,2])
Generalized seizures
Item
Generalized seizures
boolean
C0234533 (UMLS CUI [1])
Item
Tonic clonic seizures (in any combination)
integer
C0748577 (UMLS CUI [1])
Code List
Tonic clonic seizures (in any combination)
Item
Absence
integer
C0014553 (UMLS CUI [1])
Item
Generalized Seizure Typical
integer
C0311334 (UMLS CUI [1])
Code List
Generalized Seizure Typical
Item
Generalized Seizure Atypical
integer
C0595948 (UMLS CUI [1])
Code List
Generalized Seizure Atypical
Item
Generalized Seizure Myoclonic absence
integer
C0393703 (UMLS CUI [1])
Code List
Generalized Seizure Myoclonic absence
Item
Generalized Seizure Eyelid myoclonia
integer
C4023513 (UMLS CUI [1])
Code List
Generalized Seizure Eyelid myoclonia
Item
Generalized Seizure Myoclonic
integer
C0014550 (UMLS CUI [1])
Code List
Generalized Seizure Myoclonic
Item
Generalized Seizure Myoclonic atonic
integer
C0393702 (UMLS CUI [1])
Code List
Generalized Seizure Myoclonic atonic
Item
Generalized Seizure Myoclonic tonic
integer
C0014550 (UMLS CUI [1,1])
C0270844 (UMLS CUI [1,2])
Code List
Generalized Seizure Myoclonic tonic
Item
Generalized Seizure Clonic
integer
C0234535 (UMLS CUI [1])
Code List
Generalized Seizure Clonic
Item
Generalized seizures tonic
integer
C0270844 (UMLS CUI [1])
Code List
Generalized seizures tonic
Item
Generalized seizures atonic
integer
C2228222 (UMLS CUI [1])
Code List
Generalized seizures atonic
Focal seizures
Item
Focal seizures
boolean
C0751495 (UMLS CUI [1])
Item
Focal Seizure without impairment of consciousness or responsiveness
integer
C0751495 (UMLS CUI [1])
Code List
Focal Seizure without impairment of consciousness or responsiveness
Item
Focal Seizure with observable motor or autonomic components (roughly corresponds to the concept of “simple partial seizure”)
integer
C0016399 (UMLS CUI [1])
Code List
Focal Seizure with observable motor or autonomic components (roughly corresponds to the concept of “simple partial seizure”)
Item
Focal Seizure involving subjective sensory or psychic phenomena only (corresponds to the concept of “aura”)
integer
C0752322 (UMLS CUI [1])
Code List
Focal Seizure involving subjective sensory or psychic phenomena only (corresponds to the concept of “aura”)
Item
Focal Seizure with impairment of consciousness or responsiveness (roughly corresponds to the concept of “complex partial seizure”)
integer
C0270834 (UMLS CUI [1])
Code List
Focal Seizure with impairment of consciousness or responsiveness (roughly corresponds to the concept of “complex partial seizure”)
Item
Focal Seizure evolving to a bilateral, convulsive seizure (involving tonic, clonic, or tonic and clonic components; replaces the term “secondarily generalized seizure”)
integer
C2875090 (UMLS CUI [1])
Code List
Focal Seizure evolving to a bilateral, convulsive seizure (involving tonic, clonic, or tonic and clonic components; replaces the term “secondarily generalized seizure”)
Unclassified Seizure
Item
Unclassified Seizure
boolean
C0270826 (UMLS CUI [1])
Item
Unclassified Seizure Epileptic spasms – focal or generalized
integer
C0270826 (UMLS CUI [1])
Code List
Unclassified Seizure Epileptic spasms – focal or generalized
Item
Unclassified Seizure
integer
C0270826 (UMLS CUI [1])
Code List
Unclassified Seizure
Item
If two or more seizure types were selected as present, rate the confidence level that these are distinct seizure types
integer
C0518578 (UMLS CUI [1])
Code List
If two or more seizure types were selected as present, rate the confidence level that these are distinct seizure types
CL Item
0 No Confidence (1)
Date of completion
Item
Date of completion of this form
date
C0011008 (UMLS CUI [1])
Information complete
Item
Information complete up to (mm/dd/yyyy)
date
C0205197 (UMLS CUI [1,1])
C0012972 (UMLS CUI [1,2])
Item
Benign familial neonatal epilepsy (BFNE)
integer
C0220669 (UMLS CUI [1])
Code List
Benign familial neonatal epilepsy (BFNE)
Item
Early myoclonic encephalopathy (EME)
integer
C0270855 (UMLS CUI [1])
Code List
Early myoclonic encephalopathy (EME)
Item
Ohtahara syndrome
integer
C0393706 (UMLS CUI [1])
Code List
Ohtahara syndrome
Item
Epilepsy of infancy with migrating focal seizures
integer
C1858477 (UMLS CUI [1,1])
C0231330 (UMLS CUI [1,2])
Code List
Epilepsy of infancy with migrating focal seizures
Item
West syndromes
integer
C0037769 (UMLS CUI [1])
Item
Myoclonic epilepsy in infancy (MEI)
integer
C0917800 (UMLS CUI [1])
Code List
Myoclonic epilepsy in infancy (MEI)
Item
Benign infantile epilepsy
integer
C0751120 (UMLS CUI [1])
Code List
Benign infantile epilepsy
Item
Benign familial infantile epilepsy
integer
C0391958 (UMLS CUI [1,1])
C0205183 (UMLS CUI [1,2])
C0231330 (UMLS CUI [1,3])
Code List
Benign familial infantile epilepsy
Item
Dravet syndrome
integer
C0751122 (UMLS CUI [1])
Code List
Dravet syndrome
Item
Myoclonic encephalopathy in nonprogressive disorders
integer
C0270855 (UMLS CUI [1])
Code List
Myoclonic encephalopathy in nonprogressive disorders
Item
Childhood Febrile seizures plus
integer
C0009952 (UMLS CUI [1])
Code List
Childhood Febrile seizures plus
Item
Early onset benign childhood occipital epilepsy (Panayiotopoulos type)
integer
C0393676 (UMLS CUI [1])
Code List
Early onset benign childhood occipital epilepsy (Panayiotopoulos type)
Item
Childhood Epilepsy with myoclonic atonic seizures
integer
C0393702 (UMLS CUI [1])
Code List
Childhood Epilepsy with myoclonic atonic seizures
Item
Benign childhood epilepsy with centrotemporal spikes (BCECTS)
integer
C2363129 (UMLS CUI [1])
Code List
Benign childhood epilepsy with centrotemporal spikes (BCECTS)
Item
Autosomal-dominant nocturnal frontal lobe epilepsy (ADNFLE)
integer
C3696898 (UMLS CUI [1])
Code List
Autosomal-dominant nocturnal frontal lobe epilepsy (ADNFLE)
Item
Late onset childhood occipital epilepsy (Gastaut type)
integer
C0393677 (UMLS CUI [1])
Code List
Late onset childhood occipital epilepsy (Gastaut type)
Item
Epilepsy with myoclonic absences
integer
C0393703 (UMLS CUI [1])
Code List
Epilepsy with myoclonic absences
Item
Lennox-Gastaut syndrome
integer
C0238111 (UMLS CUI [1])
Code List
Lennox-Gastaut syndrome
Item
Epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS)
integer
C3806403 (UMLS CUI [1])
Code List
Epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS)
Item
Landau-Kleffner syndrome (LKS)
integer
C0282512 (UMLS CUI [1])
Code List
Landau-Kleffner syndrome (LKS)
Item
Childhood absence epilepsy (CAE)
integer
C3263988 (UMLS CUI [1])
Code List
Childhood absence epilepsy (CAE)
Item
Juvenile absence epilepsy (JAE)
integer
C1833495 (UMLS CUI [1])
Code List
Juvenile absence epilepsy (JAE)
Item
Other familial temporal lobe epilepsies
integer
C1842564 (UMLS CUI [1])
Code List
Other familial temporal lobe epilepsies
Item
Juvenile myoclonic epilepsy
integer
C0270853 (UMLS CUI [1])
Code List
Juvenile myoclonic epilepsy
Item
Progressive myoclonus epilepsies
integer
C0751778 (UMLS CUI [1])
Code List
Progressive myoclonus epilepsies
Item
Autosomal Dominant Epilepsy with Auditory Features (ADEAF)
integer
C1838062 (UMLS CUI [1])
Code List
Autosomal Dominant Epilepsy with Auditory Features (ADEAF)
Item
Epilepsy with generalized tonic-clonic seizures alone
integer
C1843234 (UMLS CUI [1])
Code List
Epilepsy with generalized tonic-clonic seizures alone
Item
Familial focal epilepsy with variable foci (childhood to adult)
integer
C1858477 (UMLS CUI [1])
Code List
Familial focal epilepsy with variable foci (childhood to adult)
Item
Reflex epilepsies
integer
C0270857 (UMLS CUI [1])
Code List
Reflex epilepsies
Item
Mesial temporal lobe epilepsy
integer
C1968848 (UMLS CUI [1])
Code List
Mesial temporal lobe epilepsy
Item
Rasmussen syndrome
integer
C0393484 (UMLS CUI [1])
Code List
Rasmussen syndrome
Item
Gelastic seizures with hypothalamic hamartoma
integer
C0270820 (UMLS CUI [1,1])
C0342418 (UMLS CUI [1,2])
Code List
Gelastic seizures with hypothalamic hamartoma
Item
Temporal lobe epilepsy
integer
C0014556 (UMLS CUI [1])
Code List
Temporal lobe epilepsy
Item
Frontal lobe epilepsy
integer
C0085541 (UMLS CUI [1])
Code List
Frontal lobe epilepsy
Item
Occipital lobe epilepsy
integer
C0393691 (UMLS CUI [1])
Code List
Occipital lobe epilepsy
Item
Parietal lobe epilepsy
integer
C0393690 (UMLS CUI [1])
Code List
Parietal lobe epilepsy
Item
Focal epilepsy (specific localization unknown)
integer
C0014547 (UMLS CUI [1])
Code List
Focal epilepsy (specific localization unknown)
Item
The epilepsy does not fit into one of these specific electro-clinical or distinctive constellations categories
integer
C0154722 (UMLS CUI [1])
Code List
The epilepsy does not fit into one of these specific electro-clinical or distinctive constellations categories
Item
If two or more epilepsy syndromes were selected as present, rate the confidence level that these are distinct syndromes
integer
C0518578 (UMLS CUI [1])
Code List
If two or more epilepsy syndromes were selected as present, rate the confidence level that these are distinct syndromes
CL Item
0 No Confidence (1)