Questionnaire

This questionnaire was created to gain the understanding of attitudes and experiences of those that are experiencing Juvenile Myoclonic Epilepsy (JME).  By gathering this information, the researcher can conclude how participants feel about their diagnosis of JME and also how this impairment affects their quality of life.

1.  At what age were you diagnosed with Juvenile Myoclonic Epilepsy (JME)?
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2.  Are you currently taking medications to help with symptoms of JME? Yes or No        (circle one)
     If so, what types of symptoms do these medications improve?
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3.  Do you have a family of your own (spouse or children)?  Yes or No (circle one)
     If so, how do you feel like your diagnosis of JME affects them?
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If you do not have children, did your diagnosis of JME hinder you on having     children?  Yes or No (circle one)

4.  How does your diagnosis of JME affect your schoolwork or work capabilities?
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5.  Are you currently using any type of medical equipment to help you to get around (includes wheelchair, crutches, walker, etc.)? Yes or No (circle one)
     If so, what type of medical equipment are you using?
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6.  How do you feel compared to others around you that do not have epilepsy?
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7.  How has epilepsy affected your capability to drive?
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8.  What medical services are you involved with to help your everyday life (includes housekeeping, at-home nurses, Meals on Wheels, etc.)?
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9.  How often do you experience seizures (includes grand mal, petite mal, absence, myoclonic jerks)?
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10.  Do you have to have a caretaker with you at all times?  Yes or No (circle one)
       If so, how do you feel about having to be supervised at all times?
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11.  What goals did you have that your epilepsy has hindered you to achieve?
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12.  How has epilepsy affected you physically?
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13.  How has epilepsy affected you mentally?
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14.  How has epilepsy affected you socially?
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15.  Are you involved in any type of support group, blog, or foundation that helps you to cope with epilepsy?  Yes or No (circle one)
       If so, what are you involved with?
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