Department of Neurology
Epilepsy vs NES Questionnaire Print E-mail

For Use by Physicians Only

This questionnaire is designed to assist physicians in determining whether seizure events are due to an epileptic or non-epileptic etiology. The questionnaire is not a stand-alone diagnostic tool. Rather, the information it provides must be used in the context of a complete clinical evaluation by a trained physician. As with any questionnaire designed to assist in patient diagnosis, accurate results are not guaranteed.

Check the following that apply to the patient/client/person:

Headache

 Hypothyroidism

Depression

 Irritable Bowel Syndrome

Anxiety

 Chronic Pain Syndrome

Fibromyalgia

 Bipolar Disorder

Mitral Valve Prolapse

If an EEG was done, were the results suggestive of epilepsy:

Yes

No

EEG not available

Number of allergies (anti-epileptic medicines not included)

Patient/Client/Person Age in years

Patient/Client/Person Age at onset of seizure(s)

Contact/Feedback for the Epilepsy Diagnosis page