1. Patient ..., born ...
Case report

2. History Family history: ... Perinatal risk factors: ...
Potential initial insults: ... (febrile seizures, CNS inflammation, brain surgery, head trauma ...)
Co-morbidity: ...
Social history: ...

3. Seizures / AED Age at seizure onset: ... Seizure frequency: ...
History of status epilepticus: Y/N
Longest seizure-free period: ...
AED: (effective / ineffective)
Current medication: ...

4. Seizure types
Try to list all seizure types from the patient‘s history, not only current or monitored seizures
Short description would be better than a classification (or provide both)
Don‘t miss description of auras!
...

5. Neurological finding
Normal / Abnormal: (hemiparesis, visual field defects, aphasia ...)
Handedness: ...
Other changes in general appearance: ...
Neuropsychology: ... (done / not done, most important findings)

6. Scalp EEG – video/EEG Interictal: ... (short summary)
Semiology of monitored seizures: ... (specify only if different from seizure types above!)
Video/EEG localization hypothesis: ... (if possible)

7. Brain MRI Finding: ... (short summary)
MRI localization hypothesis: ... (if possible)

8. Other diagnostic tests
For example: CT, fMRI, MR spectroscopy, PET, interictal/ictal SPECT, DSA, Wada test ...
If done: ... (list at individual sheets)
Finding: ...
Localization hypothesis: ... (if possible)

9. Summary
Localization hypothesis may be provided in few items or use the table below (not necessary!)
Right
F C P T O
Undetermined
Left
F C P T O
Semiology
Interictal EEG
Ictal EEG
MRI
SPECT
PET
Neuropsychology

10. Epilepsy surgery proposal
Type of surgery: ... (resective, disconnection, stimulation)
Type of resective surgery (if indicated): ... (lesionectomy, extended lesionectomy, standardized resection, tailored resection, hemispherectomy ...)
Planned intracranial EEG study: ... (none, intraoperative ECoG, long-term intracranial EEG ...)
Open questions: ... (e.g., clarity of hypothesis, expected outcome, risks)