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Posted by Diane on February 15, 2000 at 10:31:08:

In Reply to: Adults with short term memory loss. Help! posted by Keith on February 14, 2000 at 22:05:33:

: Hi, I am an occupational therapy senior at the University of Oklahoma Health Sciences Center. I am researching on the topic of Short Term Memory Loss (STM) and Epilepsy. I have been living with epilepsy for 23 years now and have had dozens of seizures. My goal is to identify if a connection exists between the seizures and STM loss. I am collecting data for my project. If would like to assist me bye answering a nine question questionnaire, that takes about 5 minutes to complete, it would be greatly appreciated. There are two ways you can do this by answering the questions below and replying back or cut and paste the questionnaire and e-mailing it to:
: kparr@email.ouhsc.edu
: thank you again keith
: QUESTIONNAIRE
: Short Term Memory Loss and Epilepsy
: Please answer the following questions as they pertain to you. All findings will be used CONFIDENTIALLY as data in a research project.

: 1. _______ MALE ____x___ FEMALE

: 2. AGE:
: _______ 18-29
: ____x___30-39
: _______ 40-49
: _______ 50-59
: _______ 60-69
: _______ 70+

: 3. TYPE OF SEIZURES THAT YOU HAVE: ( please identify any that you have if known)
: _______ Not sure
: __x____ Tonic-Clonic (Gran-mal)
: _______ Simple partial
: _______ Complex Partial
: _______ Absence (Petit-mal)
: _______ Acute repetitive ( 2 or more convulsions with in hours)
: _______ Status Epilepticus (recurrent convulsions lasting more than 20 minutes)

: 4. WHEN DID YOUR LAST SEIZURE OCCUR
: __1987___________________________________

: 5. FREQUENCY OF SEIZURES
: _______ Daily
: _______ Weekly
: _______ Monthly
: _______ Yearly

: 6. ANTICONVULSION MEDICATIONS TAKEN:
: _______ Phenytoin (Dilantin)
: _______ Valporate (Depakene)
: __x____ Phenobarbital
: _______ Primidone (Mysoline)
: _______ Zorantin
: _______ Clonazepam (Klonopin
: __x____ Carbamazrpine (Tegretol, Carbatrol)
: _______ Gabapentin (Neurontin)
: _______ Lamotigine (Lamictal)
: _______ Topiramate (Topamax)
: _______ Not controlled by medication
: _______ Not sure of the name

: Other_________________________________________________________

: 7. DO YOU EXPERIENCE SHORT TERM MEMORY LOSS?
: __x___ YES
: _______ NO

: 8. IF YES, WHAT PART OF YOUR DAILY ACTIVITIES IS EFFECTED BY SHORT TERM MEMORY LOSS? (Please check all that apply)
: __x____ Cooking
: __x____ Caring for child/parent
: __x____ Cleaning
: __x____ Medication routine
: __x____ School
: __x____ Shopping
: __xx___ Work
: __x____ Money management
: __x____ Hygiene (showering /oral)
: _______ Driving
: _______ Leisure activities
: __x____ Keeping appointments
: Oter U=_________________________________________________________

: 9. PLEASE DESCRIBE HOW SHORT TERM MEMORY LOSS IS EFFECTING YOU.

: I have difficulty remembering most things. For instance, when working, if you ask me what happend with a particular customer 1 wk after I've dealt with them, I will not remember.

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