If you complete the Epilepsy Wellbeing Map™ online you can save a copy of your completed map to your personal computer. No personal data on either you or your epilepsy is ever collected or stored by UCB or any third party organisation when you complete the Epilepsy Wellbeing Map™ online.
A print version of the map is available here: Download Print Version
You can compare versions of the maps that you have completed on different occasions to see how your experiences have changed over time. To compare two maps, both maps need to be saved on your computer.
You will not be able to change the individual maps when you compare them to each other.
To compare the maps, follow the steps below:
STEP 1: Click on the Browse button under the First map heading below and find the first map to be compared. Select the first map by clicking on it
STEP 2:
Repeat this process for the second map, then click on ‘Compare’
- 0 = No impact
- 1 = Occasionally impacts
- 2 = Sometimes impacts
- 3 = Often impacts
- 4 = Dramatic impact
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To save this map to my computer, click on "Save as PDF"
The aspect I want to focus on the most is:
Next
My next doctor visit:
List the three most important questions you wish to ask your doctor at your next consultation:
I am taking the following medications for my Epilepsy*:
| Medication (substance) | Amount per day? | Amount per day? | For approx. how long? | For approx. how long? |
| Diamox® (acetazolamide) | ||||
| Dilantin® (Phenytoin) | ||||
| Epilim® (sodium valproate) | ||||
| Gabitril® (tiagabine) | ||||
| Keppra® (levetiracetam) | ||||
| Lamictal® (lamotrigine) | ||||
| Lyrica® (pregabalin) | ||||
| Mysoline® (primidone) | ||||
| Neurontin® (gabapentin) | ||||
| Ospolot® (sulthiame) | ||||
| Phenobarbitone (phenobarbitone) | ||||
| Rivotril® (clonazepam) | ||||
| Sabril® (vigabatrin) | ||||
| Tegretol® (carbamazepine) | ||||
| Topimax® (topiramate) | ||||
| Trileptal® (oxcarbazepine) | ||||
| Vimpat® (lacosamide) | ||||
| Zarontin® (ethosuximide) | ||||
| Zonegran® (zonisamide) | ||||
| *http://www.pbs.gov.au/browse/body-system?depth=3&codes=n03a | ||||
Other medication/s
To save this map to my computer, click on "Save as PDF"
Next update of my Map:
THANK YOU!
Your Well-Being Map™ comparison PDF will be generated soon. Please wait for the download to begin.
