YOU MUST BE 18 YEARS OF AGE TO TAKE THIS QUIZ

Grading Scale

0= You never experience this

1= 0 to 33% of the time, you experience this

2= 33 to 66% of the time, you experience this

3= 66 to 100% of the time, you experience this

Frontal lobe Prefrontal,
Dorsolateral and Orbitofrontal
(Areas 9, 10, 11, and 12)

Frontal Lobe Precentral and
Supplementary
Motor Areas (Area 4 and 6)

Frontal Lobe Broca’s Motor Speech
Area (Area 44 and 45)

Parietal Somatosensory Area and Parietal Superior Lobule
(Areas 3,1,2 and 7)

Parietal Inferior Lobule
(Area 39 and 40)

Temporal Lobe Auditory Cortex
(Areas 41, 42)

Medial Temporal lobe and
Hippocampus

Occipital Lobe
(Area, 17, 18, and 19)

Cerebellum - Spinocerebellum

Cerebellum - Cerebrocerebellum

Cerebellum - Vestibulocerebellum

Basal Ganglia Direct Pathway

Basal Ganglia Indirect Pathway

Autonomic Reduced
Parasympathetic Activity

Autonomic Increased
Sympathetic Activity

INSTRUCTIONS:
The purpose of this questionnaire is to identify difficulties that you may be experiencing. Please select yes or no.

 Epileptiform Activity