Digicon

@if (isset(session()->get('doctor')['vCentralCode'])) {{ session()->get('doctor')['vCentralCode'] }} @endif

@if (isset(session()->get('doctor')['vCentralCode']))

Logout

@endif

@csrf

@if (isset(session()->get('doctor')['vCentralCode']))

Back

@else

@endif

(To be filled only by physician)

A retrospective cross-sectional, observational survey study to analyse role of levetiracetam as monotherapy in partial onset seizures with newly diagnosed epilepsy.

Inclusion criteria:

Patients of partial onset seizures with or without secondary generalization in patients with 16 years of age with newly diagnosed epilepsy taking levetiracetam.

DEMOGRAPHIC DATA

Initials*

Serial No.*

Age (yr) *

Weight (kgs)*

Gender *

Male Female

Marital status *

Single Married

Name of clinic/hospital*

Date of data collection*

DETAILS OF DIAGNOSIS AND TREATMENT

Comorbidities, if Yes

Conditions	YES or NO	Year	Months
Obesity
Diabetes
Depression
Anxiety
Cerebrovascular accident
Mental retardation
Attention-deficit hyperactivity disorder
Learning disability
Mention others if any

Place in therapy *

Use of levetiracetam in this patient as:

First-line option Other

Total daily dose of levetiracetam *

250mg 500mg 750mg 1000mg 1500mg 2000mg Other

Reasons for choosing Levetiracetam *

Kindly tick the potential reasons for choosing in this patient

Broad spectrum

Multiple Mechanism of action

Available in different dosage forms

Devoid of enzyme-inducing properties

Presence of Co-morbidities

Patient acceptance

Better quality of life

Concomitant medication, if any

Sr. No	Generic Name	Route & Dose	Duration (months)
1
2
3
4
5

Any other comments