Adult Neurology Residency

Adult Neurology Residency

Epilepsy

Introduction

The UW Department of Neurology strives to provide the best possible care for patients with epileptic disorders, both at the UW and VA Hospitals. Residents rotate on this service during the PGY-2 and PGY-3 years, with additional elective time available for PGY-4 residents who are so interested. The rotation encompasses both inpatient and outpatient care.

Goals

PGY-2 Residents: For junior residents, this rotation has two separate but interrelated goals. First, each resident on the epilepsy service will develop the skills necessary to evaluate, treat, and counsel patients and families with epileptic disorders. Secondly, each resident will learn the principles of electroencephalography and develop confidence in correctly interpreting EEG studies, including long-term monitoring studies of patients in the epilepsy monitoring and intensive care units.

PGY-3-4 Residents: As the resident gains knowledge and clinical skills, patient care and EEG reading responsibilities will be increased at the discretion of the attending physician. Independence is encouraged, but at all times each resident will be appropriately supervised by the faculty.

Teaching opportunities are numerous and will include presentations at morning report as well as medical student teaching.

Objectives and Evaluation Matrix

As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the end-of-rotation evaluation. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).

Upon completion of the curriculum, residents will . . .
#DescriptionMilestones
1Obtain an epilepsy history and classify the events and the epilepsy syndromePC1, PC2, PC3, PC4, PC5, PC8, MK1
2Develop clinic patients’ treatment plansPC3, PC4, MK2
3Evaluate patients in the EMU and develop differential diagnosis regarding event etiology, seizure/epilepsy localization, and epilepsy etiology based on history, exam, and prior eventsPC1, PC2, PC3, PC5, PC9, MK1, MK2
4Counsel inpatients and outpatients with spells/epilepsy regarding study resultsPC4, PC5, PC12, IC1
5Manage seizure emergencies among inpatientsPC3, PC5, PC6, PC9, MK2
6Interpret routine EEGs, recognizing artifacts, normal variants, and ictal patternsPC9
7Interpret emergent EEG and cEEG studies and recommend treatment plans to the treating teamPC5, PC6, PC9, IC3, IC4
Milestones
Please grade the resident on any of the following milestones you were able to evaluate during this rotation:
SP3, SP4, PL1, PL2, PR1, PR2, PR3, IC2

Schedule

 MondayTuesdayWednesdayThursdayFriday
AMVA epilepsy clinic and EMU admissions: Dr. KotloskiEMUEMUEMUEpilepsy Conference if possible 12-1

EMU

PMEMU admissionsEEG readingEEG readingEEG readingEEG reading
  • Prior to the start of the rotation, check in with the EMU attending by sending them an email on the Thursday or Friday beforehand to plan out the what and where on the first day. This is especially helpful, since there is not always a fellow on service.
  • The resident will spend most mornings rounding in the epilepsy monitoring unit (EMU) and reading those patients’ EEGs.
  • In the afternoons, the resident will spend time reading outpatient EEGs and composing reports. Typical volume for a resident is 2 to 4 outpatient EEGs per day.
  • Learning may be supplemented with inpatient continuous monitoring study review.

Work Hours

The estimated number of work hours per week is 45. There is no call responsibility.

Suggested References

Fisch, B. J., & Spehlmann, R. (2009). Fisch and Spehlmann’s EEG primer : basic principles of digital and analog EEG. Amsterdam [etc.]: Elsevier.

Husain, A., (2023) Current Practice of Clinical Electroencephalography, 5th Ed.

Wyllie, E., Gidal, B. E., Goodkin, H. P., Loddenkemper, T., & Sirven, J. I. (2015). Wyllie’s treatment of epilepsy : principles and practice.

Suggested free online resources / viewing

EEG Talk on YouTube

Learningeeg.com

https://pn.bmj.com/content/21/6/48  This is a pdf with embedded videos for an overview of focal epilepsy localization and seizure semiology

https://www.ncbi.nlm.nih.gov/books/NBK390354/ Electroencephalography (EEG): An Introductory Text and Atlas of Normal and Abnormal Findings in Adults, Children, and Infants

Latest revision:  05/03/2024 Dr. Wheeler