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Questionnaire
Questionnaire
Residency: tribe:
Hereditary disease
Pathogenic causes
Unknown origin
Neurological disease
A supernatural power
Other causes……
3-what is the epilepsy associated with:
Tonic–clonic movements
Brief loss of consciousness
Muscle twitching
Other
4-Have you read or heard about epilepsy?
Yes ( ) no ( )
5-Is it treatable?
1
Yes ( ) no ( )
6- Could it be transmitted?
Yes ( ) no ( )
Yes ( ) no ( )
…………………………………………
Yes ( ) no ( )……………………………………..
Yes ( ) no ( )
……………………………………………..
12-Do you think that patients with epilepsy are intelligent like other
people?
Yes( ) no( )
13-Do you think that the patient with epilepsy is insane?
Yes( ) no( )
14-Do you shake hands with patient with epilepsy?
Yes( ) no( )
15-Do you allow your child to play with a child with epilepsy?
Yes( ) no( )
16-Do you allow your son to marry a girl with epilepsy Or vice versa ?
2
Yes( ) no( )
17-Do you think that patients with epilepsy can have children?
Yes( ) no( )
18-Do you think that a patient with epilepsy can get a high academic
degree?
Yes( ) no( )