Epilepsy Daily Management Progress Chart

Patient Information

• Name: _________________
• Date of Birth: _________________
• Emergency Contact: _________________
• Treating Neurologist: _________________

Daily Seizure Log

Date: //___

Seizure Details

• Time of seizure: : □ AM □ PM
• Duration: _____ minutes
• Type of seizure: □ Focal □ Generalized □ Unknown
• Warning signs (aura): □ Yes □ No

Triggers (check all that apply)

□ Missed medication □ Lack of sleep □ Stress □ Illness/fever □ Flashing lights □ Other: _________________

Post-Seizure Symptoms

□ Confusion □ Headache □ Fatigue □ Muscle soreness □ Other: _________________

Medication Log

Current Medications

Daily Wellness Factors

• Hours of sleep: _____
• Stress level (1-10): _____
• Physical activity: □ None □ Light □ Moderate □ Intense
• Diet changes: _________________

Notes for Healthcare Provider

Monthly Summary

• Total seizures this month: _____
• Days seizure-free: _____
• Medication changes: _____
• Side effects observed: _____

Bring this chart to all neurology appointments