Daily Seizure and Epilepsy Management Tracker

Patient Information

Name: ___________________ Date of Birth: //___ Neurologist: ________________ Emergency Contact: ________________

Daily Seizure Log

Date: //___

Seizure Details

• Time seizure began: _______
• Duration: _____ minutes
• Type of seizure: □ Focal □ Generalized □ Unknown

Symptoms (check all that apply)

□ Aura/Warning signs □ Loss of consciousness □ Muscle stiffness □ Jerking movements □ Confusion after seizure □ Other: ________________

Medication Compliance

Morning Medications:

• Name: _____________ Dose: _____ □ Taken □ Missed
• Name: _____________ Dose: _____ □ Taken □ Missed

Evening Medications:

• Name: _____________ Dose: _____ □ Taken □ Missed
• Name: _____________ Dose: _____ □ Taken □ Missed

Potential Triggers

□ Missed medication □ Sleep deprivation □ Stress □ Illness/fever □ Alcohol use □ Flashing lights □ Other: ________________

Daily Wellness Factors

Hours of sleep: _____ Stress level (1-10): _____ Mood: □ Good □ Fair □ Poor

Emergency Action Taken

□ None needed □ Emergency medication given □ Called doctor □ Visited ER □ Other: ________________

Notes

Bring this log to all neurology appointments