Children’s National Epilepsy Center

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			Patient ID	Year of Surgery	Surgery Details	Age at Diagnosis (years)	Sex	Race	Ethnicity	Etiology	Structural Etiology	Epilepsy Type	Seizure Types	Syndrome	Previous Treatment Surgery? (including neuromodulation)	Referred to Level 4	Primary Payer	Type(s) of Surgery	Intracranial EEG Details	Neurostimulation Details	Resection, Disconnection, Ablation Details	Type of Corpus Callostomy	Intent of Surgery	Location of treatment or target	Planned Treatment Surgery	Intraoperative ECOG	Complications	Please Describe Other Complications	Additional Comments	Date Created
			Patient ID	Year of Surgery	Surgery Details	Age at Diagnosis (years)	Sex	Race	Ethnicity	Etiology	Structural Etiology	Epilepsy Type	Seizure Types	Syndrome	Previous Treatment Surgery? (including neuromodulation)	Referred to Level 4	Primary Payer	Type(s) of Surgery	Intracranial EEG Details	Neurostimulation Details	Resection, Disconnection, Ablation Details	Type of Corpus Callostomy	Intent of Surgery	Location of treatment or target	Planned Treatment Surgery	Intraoperative ECOG	Complications	Please Describe Other Complications	Additional Comments	Date Created

Medical Director: John M. Schreiber

, MDMD

Co-Medical Director: William D. Gaillard,

MD

NAEC recognizes Children’s National Epilepsy Center for their valuable contribution to the NAEC Surgical Data Pilot Program

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