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.
This is an accordion element with a series of buttons that open and close related content panels.
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).
Rotation Objectives
Upon completion of the curriculum, resident will…
# | Description | Milestones |
1 | Obtain an epilepsy history and classify the events and the epilepsy syndrome | PC1, PC2, PC3, PC4, PC5, PC8, MK1 |
2 | Develop clinic patients’ treatment plans | PC3, PC4, MK2 |
3 | Evaluate patients in the EMU and develop differential diagnosis regarding event etiology, seizure/epilepsy localization, and epilepsy etiology based on history, exam, and prior events | PC1, PC2, PC3, PC5, PC9, MK1, MK2 |
4 | Counsel inpatients and outpatients with spells/epilepsy regarding study results | PC4, PC5, PC12, IC1 |
5 | Manage seizure emergencies among inpatients | PC3, PC5, PC6, PC9, MK2 |
6 | Interpret routine EEGs, recognizing artifacts, normal variants, and ictal patterns | PC9 |
7 | Interpret emergent EEG and cEEG studies and recommend treatment plans to the treating team | PC5, PC6, PC9, IC3, IC4 |
Schedule
Monday | Tuesday | Wednesday | Thursday | Friday | |
AM | VA epilepsy clinic and EMU admissions: Dr. Kotloski | EMU | EMU | EMU | Epilepsy Conference if possible 12-1 EMU |
PM | EMU admissions | EEG reading | EEG reading | EEG reading | EEG 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.
Suggestsed 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
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