TLE Checklist

TLE CHECKLIST

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List of symptoms by type:

Sensory

1. Olfactory (smell) illusions
2. Taste illusions
3. Visual illusions
4. Illusions of movement
5. "Mice" running
6. Tactile (touch) illusions
7. Episodic numbness
8. Episodic tinnitus
9. "Telephone" ringing
10. Micropsia
11. Macropsia
12. Episodic vertigo
13. Episodic dizziness

Sub Total: ____


Psychological

1. Suicidal ideation
2. Dysphoric spells
3. Panic spells
4. Temper outbursts
5. Unrecalled anger
6. Angry sleep
7. Nightmares


Sub Total: ____


Cognitive

1. Speech problems
2. Aphasia (Word-finding lapses)
3. Speaking jargon
4. Confusional spells
5. Environmental distortion
6. Déjà Vu
7. Jamais Vu
8. Memory gaps
9. Discontinuous TV viewing
10. Automatic driving
11. Unrecalled behavior
12. Visual fixation
13. Staring spells
14. Mental decline
15. Loss of consciousness
16. Irresistible sleepiness


Sub Total: ____

Autonomic

1. Headaches
2. Other head pain
3. Urinary urgency
4. Epigastric sensation
5. Nocturnal sweating

Sub Total: ____

TOTAL: ____